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DELTA DENTAL OF VIRGINIA FOUNDATION INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
DELTA DENTAL OF VIRGINIA FOUNDATION INC (EIN 45-3230862)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-15
IRS object ID
201823199349312197
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-15T14:47:07-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN540504608PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BROWN EDWARDS & COMPANY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1319 MCCLANAHAN STREET SWAddressLine1Txt
CityROANOKECityNm
State AbbreviationVAStateAbbreviationCd
ZIP24014ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN453230862EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF VIRGINIA FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDELTBusinessNameControlTxt
Phone5409898000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14818 STARKEY ROADAddressLine1Txt
CityROANOKECityNm
State AbbreviationVAStateAbbreviationCd
ZIP24018ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonFRANK L LUCIAPersonNm
Person TitlePRESIDENT & CEOPersonTitleTxt
Phone5409898000PhoneNum
Signature2018-11-05SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonM C WINGFIELDPreparerPersonNm
PTINP00005971PTIN
Phone5403450936PhoneNum
Preparation2018-11-05PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address206.248.228.130IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-05IPDt
IP Tm10:04:14IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdD0156BD46B4B1FE921C9503B1D7FFBF99E37DBABAtSubmissionCreationDeviceId
At Submission Filing Device IdCE530EA759AC3AF6BB0EECEF8950573E07121913AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerFRANK L LUCIAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14818 STARKEY ROADAddressLine1Txt
CityROANOKECityNm
State AbbreviationVAStateAbbreviationCd
ZIP24018ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$459,868GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.DELTADENTALVA.COM/DDVAFOUNDATION.ASPXWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateVALegalDomicileStateCd
Activity Or MissionIMPROVE THE PUBLIC'S ORAL HEALTH IN THE COMMONWEALTH OF VIRGINIA.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$322,259PYContributionsGrantsAmt
CY Contributions Grants$459,868CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$322,259PYTotalRevenueAmt
CY Total Revenue$459,868CYTotalRevenueAmt
PY Grants And Similar Paid$231,500PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$370,500CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$19,747PYOtherExpensesAmt
CY Other Expenses$33,498CYOtherExpensesAmt
PY Total Expenses$251,247PYTotalExpensesAmt
CY Total Expenses$403,998CYTotalExpensesAmt
PY Revenues Less Expenses$71,012PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$55,870CYRevenuesLessExpensesAmt
Total Assets BOY$341,970TotalAssetsBOYAmt
Total Assets EOY$397,024TotalAssetsEOYAmt
Total Liabilities BOY$816TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$341,154NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$397,024NetAssetsOrFundBalancesEOYAmt
MissionTHE FOUNDATION WORKS TO IMPROVE THE ORAL HEALTH OF ALL VIRGINIANS THROUGH FINANCIAL SUPPORT OF RESEARCH AND EDUCATION INITIATIVES AND PROGRAMS THAT PROVIDE ACCESS TO CARE FOR THE UNDERSERVED.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$370,500ExpenseAmt
Grant$370,500GrantAmt
DescPROMOTION OF ORAL HEALTH CARE THROUGH EDUCATION, RESEARCH AND INCREASED ACCESS TO ORAL HEALTH CARE IN THE COMMONWEALTH OF VIRGINIA.Desc
Total Program Service Expenses$370,500TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1RJAMES BARKERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5409898000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14818 STARKEY ROADAddressLine1Txt
CityROANOKECityNm
State AbbreviationVAStateAbbreviationCd
ZIP24018ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
MR LYNDELL B BROOKS
TREASURER1.0014.00Yes (X)Yes (X)$0$38,071$0
DR BARRY WOLFE
SECRETARY1.004.00Yes (X)Yes (X)$0$28,715$0
DR HAROLD J BARRETT JR
DIRECTOR1.002.00Yes (X)$0$21,860$0
MR GORDON L GENTRY JR
DIRECTOR1.005.00Yes (X)$0$34,944$0
DR GEORGE A LEVICKI
PRESIDENT - RETIRED 11/20171.0041.00Yes (X)Yes (X)$0$1,197,351$71,596
MR FRANK L LUCIA
PRESIDENT & CEO, 11/20171.0041.00Yes (X)Yes (X)$0$61,009$1,678
DR EMANUEL W MICHAELS
FORMER DIRECTOR0.000.00$0$22,500$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,404,450TotReportableCompRltdOrgAmt
Total Other Compensation$73,274TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Related Organizations$459,868RelatedOrganizationsAmt
Total Contributions$459,868TotalContributionsAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$459,868TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$370,500TotalAmt
Program Services$370,500ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total-$1,141TotalAmt
Management And General-$1,141ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$27,644TotalAmt
Management And General$27,644ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescDENTAL CLAIMSDesc
Total$6,995TotalAmt
Management And General$6,995ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$403,998TotalAmt
Program Services$370,500ProgramServicesAmt
Management And General$33,498ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$341,970BOYAmt
EOY$386,371EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
EOY$10,653EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$341,970BOYAmt
EOY$397,024EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$816BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$816BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$341,154BOYAmt
EOY$397,024EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$341,154BOYAmt
EOY$397,024EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$341,970BOYAmt
EOY$397,024EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$55,870ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1DELTA DENTAL OF VIRGINIABusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN540844477EIN
Organization Type10OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$370,500SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$370,500SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C456Yes (1)SupportedOrgSectionC456Ind
Supported Org QualifiedYes (1)SupportedOrgQualifiedInd
Suprt Exclusively Sec170c2 BYes (1)SuprtExclusivelySec170c2BInd
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE A, PART IV, LINE 3BDELTA DENTAL OF VIRGINIA FOUNDATION ANNUALLY REQUESTS FROM DELTA DENTAL A PRO FORMA FORM 990 SCHEDULE A TO VERIFY IT MEETS THE SECTION 509(A)(2) PUBLIC SUPPORT TEST FOR ITS MOST RECENT TAX YEAR.
SCHEDULE A, PART IV, LINE 3CDELTA DENTAL OF VIRGINIA FOUNDATION HAS PROCEDURES IN PLACE TO ENSURE THAT ITS SUPPORT IS USED SOLELY FOR CHARITABLE PURPOSES. THE FOUNDATION MONITORS ALL GRANT MONIES AWARDED BY REQUIRING END-OF-YEAR UPDATES DETAILING HOW THE GRANT MONIES WERE USED.

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$459,868TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$459,868RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$459,868TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$403,998TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$403,998ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$403,998TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2017 AND 2016.ExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (41 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxtAddress Line2USAddress/AddressLine2Txt
CHILD HEALTH INVESTMENT PARTNERSHIP
1201 THIRD STREET SWROANOKEVA24016541566451501(C)(3)$5,000FLUORIDE VARNISH TREATMENTS/IN-HOME DENTAL EDUCATION
BRADLEY FREE CLINIC
1240 THIRD STREET SWROANOKEVA24016237380491501(C)(3)$15,000SPONSOR VCU DENTAL STUDENTS PROVIDING SERVICES AT THE CLINIC
OLIVET MEDICAL MINISTRY INC AKA LACKEY FREE CLINIC
1620 OLD WILLIAMSBURG ROADYORKTOWNVA23690541850915501(C)(3)$10,000DENTAL SUPPLIES
PIEDMONT REGIONAL DENTAL CLINIC INC
13296 JAMES MADISON HWY STE BORANGEVA22960270625764501(C)(3)$5,000SUPPORT FOR "SMILE TIME", A SCHOOL BASED DENTAL CHECK-UP PROGRAM
BRADLEY FREE CLINIC
1240 THIRD STREET SWROANOKEVA24016237380491501(C)(3)$5,000DENTAL SUPPLIES
VIRGINIA HEALTH CARE FOUNDATION
707 EAST MAIN STREET STE 1350RICHMONDVA23219541639924501(C)(3)$45,000DENTAL OPPORTUNITIES CHAMPION (DOC)
BOYS & GIRLS CLUBS OF THE VIRGINIA PENINSULA
11825 ROCK LANDING DRIVENEWPORT NEWSVA23606540538202501(C)(3)$5,000"SMART SMILES AT THE DENTIST" PROGRAM
CROSSOVER HEALTHCARE MINISTRY
8600 QUIOCCASIN ROAD SUITE 102RICHMONDVA23229541371067501(C)(3)$5,000SALARY SUPPORT AND DENTAL SUPPLIES
NORTHERN NECK-MIDDLESEX FREE HEALTH CLINIC
51 WILLIAM B GRAHAM COURTKILMARNOCKVA22482541679279501(C)(3)$7,500SUPPORT OF VCU DENTAL STUDENTS PROVIDING SERVICES AT THE CLINIC
OLDE TOWNE MEDICAL & DENTAL CENTER
5249 OLDE TOWNE ROADWILLIAMSBURGVA23188541663905501(C)(3)$5,000DENTAL SUPPLIES
VIRGINIA ORAL HEALTH COALITION
4200 INNSLAKE DRIVEGLEN ALLENVA23060274082359501(C)(3)$7,500EDUCATION OF MEDICAL & DENTAL PROVIDERS ABOUT THE SAFETY, EFFICACY & IMPORTANCE OF DENTAL CARE DURING PREGNANCY
BOYS & GIRLS CLUBS OF SOUTHWEST VIRGINIA
1714 9TH STREET SEROANOKEVA24013541867366501(C)(3)$5,000"SMART SMILES AT THE DENTIST" PROGRAM
CHARLOTTESVILLE FREE CLINIC
1138 ROSE HILL DRIVE SUITE 200CHARLOTTESVILLEVA22903541610405501(C)(3)$5,000DENTAL SUPPLIES
HAMPTON ECUMENICAL LODDGING & PROVISIONS (AKS DR RICHARD CLARK HELP CLINIC)
PO BOX 120525NEWPORT NEWSVA23612541209213501(C)(3)$5,000EXPAND DENTAL SERVICES
CRAIG COUNTY RURAL HEALTH CARE CORPORATION
PO BOX 223NEW CASTLEVA24127562569389501(C)(3)$10,000EXPANSION OF SCHOOL BASED ORAL HEALTH SERVICES IN CRAIG COUNTY VA
DANVILLE PITTSYLVANIA COMMUNITY SERVICES
245 HAIRSTON STREETDANVILLEVA24540540937279501(C)(3)$3,000DENTAL EXAMS FOR ADULTS WITH DEVELOPMENTAL DISABILITIES
COMMUNITY YOUTH PROGRAM AT ST JOHN'S INC
PO BOX 257ROANOKEVA24002541855451501(C)(3)$4,000ORAL HEALTH OUTREACH EDUCATION
EASTERN SHORE RURAL HEALTH SYTEM INC
20280 MARKET STREETONANCOCKVA23417510196935501(C)(3)$15,000DENTAL CHAIR TO ACCOMMODATE WHEELCHAIR BOUND PATIENTS
FAQUIER FREE CLINIC
35 ROCK POINTE LANEWARRENTONVA20186541669652501(C)(3)$4,000DENTAL EQUIPMENT
GOOCHLAND FREE CLINIC & FAMILY SERVICES
1800 SANDY HOOK ROAD PO BOX 116GLOOCHLANDVA23063541967650501(C)(3)$5,000EXPAND DENTAL SERVICES
ISLE OF WIGHT CHRISTIAN OUTREACH PROGRAM
PO BOX 253SMITHFIELDVA23431541638727501(C)(3)$5,000EXPAND DENTAL PROGRAM
LLOYD F MOSS FREE CLINIC
1301 SAM PERRY BOULEVARD STE 100FREDERICKSBURGVA22401541677934501(C)(3)$5,000DENTAL SUPPLIES
LUCY CORR FOUNDATION INC
6800 LUCY CORR BOULEVARDCHESTERFIELDVA23832542010957501(C)(3)$10,000EXPAND DENTAL CARE TO ELDERLY IN RICHMOND VA AREA
MEL LEAMAN FREE CLINIC AT EMORY & HENRY COLLEGE
PO BOX 1273MARIONVA24354541993876501(C)(3)$5,000DENTAL SUPPLIES
NORTHERN VIRGINIA DENTAL CLINIC INC
8221 WILLOW OAKS CORPORATE DR NOFAIRFAXVA22031541646071501(C)(3)$5,000DENTAL SUPPLIES450
PARK PLACE DENTAL CLINIC INC
606 W 29TH STREETNORFOLKVA23508453086608501(C)(3)$5,000DENTAL SUPPLIES
PIEDMONT VIRGINIA DENTAL HEALTH FOUNDATION
407 STARLING AVEMARTINSVILLEVA24112201468244501(C)(3)$10,000SUPPORT FOR DENTAL CLINIC PROVIDING SERVICES TO LOW INCOME ADULTS AND CHILDREN
HANOVER INTERFAITH FREE CLINICS
PO BOX 117ASHLANDVA23005412214314501(C)(3)$7,500DENTURES FOR LOW INCOME RESIDENTS
VIRGINIA DENTAL ASSOCIATION FOUNDATION
3460 MAYLAND COURTHENRICOVA23233541821602501(C)(3)$15,000MOBILE DENTAL EQUIPMENT REPLACEMENT/REPAIR & SUPPLIES FOR MISSION OF MERCY PROGRAM
WESTERN TIDEWATER FREE CLINIC
2019 MEADE PARKWAYSUFFOLKVA23434263302837501(C)(3)$5,000DENTAL SUPPLIES
ARLINGTON FREE CLINIC
2921 11TH STREET SOUTHARLINGTONVA22204541671883501(C)(3)$5,000DENTAL EQUIPMENT
CENTRAL VIRGINIA HEALTH SERVICES
PO BOX 220 25892 N JAMES MADISONNEW CANTONVA23123540887287501(C)(3)$7,500DENTAL EQUIPMENTHWY
CHRISTIAN FREE CLINIC OF BOTETOURT
PO BOX 890DALEVILLEVA24083204342697501(C)(3)$2,000DENTAL EQUIPMENT
HEALING HANDS HEALTH CENTER INC
245 MIDWAY MEDICAL PARKBRISTOLTN37620621677000501(C)(3)$10,000DENTAL SERVICES
LEWIS-GALE FOUNDATION DBA HEALTH FOCUS OF SOUTHWEST VA
PO BOX 4692ROANOKEVA24015546051298501(C)(3)$5,000DENTAL SCHOLARSHIPS
KUUMBA COMMUNITY HEALTH & WELLNESS CENTER INC
3716 MELROSE AVENUE NWROANOKEVA24017541937835501(C)(3)$5,000TRAIN DENTAL ASSISTANT AS A COMMUNITY DENTAL HEALTH COORDINATOR
PRINCE WILLIAM AREA FREE CLINIC
13900 CHURCH HILL DRIVEWOODBRIDGEVA22191541619202501(C)(3)$7,500DENTAL SERVICES
THE FENWICK FOUNDATION
23 N FENWICK STREETARLINGTONVA22201274879033501(C)(3)$5,000DENTAL SERVICES TO LOW-INCOME RESIDENTS IN LONG-TERM HEALTH CARE CENTERS
REMOTE AREA MEDICAL INC VIRGINIA BRANCH
2200 STOCK CREEK BLVEROCKFORDTN37853581647546501(C)(3)$10,000DENTAL SERVICES IN RURAL VA COMMUNITIES
VIRGINIA TECH-CARILION SCHOOL OF MEDICINE
TWO RIVERSIDE CIRCLEROANOKEVA24016264556177501(C)(3)$50,000PILOT A PROGRAM INTEGRATING ORAL HEALTH EXAMS & FLUORIDE VARNISHING FOR CHILDREN INTO FAMILY MEDICINE & PEDIATRIC PRACTICES
VIRGINIA WESTERN COMMUNITY COLLEGE EDUCATIONAL FOUNDATION INC
3093 COLONIAL AVENUEROANOKEVA24015521200913501(C)(3)$20,000DENTAL HYGIENE PROGRAM & SERVICES PROVIDED THROUGH THE FREE COMMUNITY CLINICS
FieldValueIRS element (for citing)
Total501c3 Org40Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE FOUNDATION REQUESTS A YEAR-END UPDATE OF HOW THE GRANT FUNDS WERE USED.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR GEORGE A LEVICKI
PRESIDENT - RETIRED 11/2017$0$587,010$0$455,347$0$154,994$0$54,000$0$17,596$0$1,268,947$0$0
DR EMANUEL W MICHAELS
FORMER DIRECTOR$0$22,500$0$0$0$0$0$0$0$0$0$22,500$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1BNOT APPLICABLE
PART I, LINE 4BTHE FOLLOWING LUMP SUM PAYMENTS BY A RELATED ORGANIZATION HAVE BEEN INCLUDED IN COLUMN B-III OF SCHEDULE J, PART II. THE LUMP SUM PAYMENT IN 2017 WAS EARNED OVER A PRECEDING MULTI-YEAR PERIOD. THE PLAN WAS ESTABLISHED VIA THE RELATED ORGANIZATION'S MANAGEMENT DEVELOPMENT & COMPENSATION COMMITTEE'S COMPENSATION AND BENEFIT REVIEW WHICH IS IN ACCORDANCE WITH THE PROCESS OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. THE PLAN IS IN ACCORDANCE WITH SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS AS PER IRS SECTION 457(F). THE FOLLOWING AMOUNT WAS PAID FROM A RELATED ORGANIZATION IN 2017: EMPLOYEE AMOUNT GEORGE A. LEVICKI $142,092

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 7APURSUANT TO THE ARTICLES OF INCORPORATION, THE FOUNDATION'S BOARD OF DIRECTORS ARE APPOINTED BY THE BOARD OF THE SUPPORTED ORGANIZATION, DELTA DENTAL OF VIRGINIA.
FORM 990, PART VI, SECTION B, LINE 11BMEMBERS OF THE BOARD OF DIRECTORS WILL REVIEW THE DOCUMENT AND THE REVIEW WILL BE DOCUMENTED AT THE SUBSEQUENT BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12CTHE BOARD OF DIRECTORS COMPLETE CONFLICT OF INTEREST FORMS ANNUALLY. ALL ARE FILED IN THE CORPORATE MINUTE BOOK WHICH IS REVIEWED BY OUR AUDITORS.
FORM 990, PART VI, SECTION C, LINE 19THE APPLICABLE FORMS ARE AVAILABLE FOR PUBLIC INSPECTION VIA REQUEST AND REGULATORY FILINGS.
FORM 990, PART XII, LINE 2CTHERE HAVE BEEN NO CHANGES TO DELTA DENTAL OF VIRGINIA FOUNDATION'S OVERSIGHT PROCESS OF THE AUDIT OR ITS SELECTION OF AN INDEPENDENT AUDITOR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
DELTA DENTAL OF VIRGINIA
4818 STARKEY ROADROANOKEVA24018540844477ADVANCE PUBLIC'S ORAL HEALTH BY PROVIDING QUALITY DENTAL BENEFITS.VA501(C)(4)CORVESTA INC0
CORVESTA INC
4818 STARKEY ROADROANOKEVA24018205945158HOLDING COMPANYVA501(C)(4)0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndEINEINLegal Domicile StateLegalDomicileStateCd
CORVESTA SOFTWARE SOLUTIONS PVT LTD
4818 STARKEY ROADROANOKEVA24018PROVIDES SOFTWARE DEVELOPMENT & PROGRAMMINGINN/AC0
REVOLV INC
4818 STARKEY ROADROANOKEVA24018PROVIDES TPA SERVICES TO DENTAL INSURANCE COMPANIESN/AC0271018474VA
CORVESTA LIFE INSURANCE COMPANY INC
4818 STARKEY ROADROANOKEVA24018PROVIDES LIFE INSURANCE POLICIESN/AC0860201136AZ
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd