HEALTHY SMILES INC: Form 990EZ, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HEALTHY SMILES INC (EIN 26-3105129)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-16
- IRS object ID
- 202241369349209029
- Schema version
- 2021v4.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T22:24:50-04:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263105129 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTHY SMILES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % Shannon Kruckeberg | InCareOfNm |
| Business Name Control | HEAL | BusinessNameControlTxt |
| Foreign Phone | 5073196845 | ForeignPhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 63407 130TH AVE | AddressLine1Txt |
| City | CLAREMONT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 559244656 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Shannon Kruckeberg | PersonNm |
| Person Title | Dental Hygienist | PersonTitleTxt |
| Signature | 2022-05-16 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $44,835 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $9,329 | ContributionsGiftsGrantsEtcAmt |
| Program Service Revenue | $35,506 | ProgramServiceRevenueAmt |
| Gain Or Loss From Sale Of Assets | $0 | GainOrLossFromSaleOfAssetsAmt |
| Gross Profit Loss Sls Of Invntry | $0 | GrossProfitLossSlsOfInvntryAmt |
| Total Revenue | $44,835 | TotalRevenueAmt |
| Salaries Other Comp Empl Bnft | $5,653 | SalariesOtherCompEmplBnftAmt |
| Fees And Other Pymt To Ind Cntrct | $1,053 | FeesAndOtherPymtToIndCntrctAmt |
| Occupancy Rent Utlts And Maint | $20,624 | OccupancyRentUtltsAndMaintAmt |
| Printing Publications Postage | $529 | PrintingPublicationsPostageAmt |
| Other Expenses Total | $16,860 | OtherExpensesTotalAmt |
| Total Expenses | $44,719 | TotalExpensesAmt |
| Excess Or Deficit For Year | $116 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $6,535 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,651 | NetAssetsOrFundBalancesEOYAmt |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $401 | BOYAmt |
| EOY | $517 | EOYAmt |
Other Assets Total Detail OtherAssetsTotalDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,134 | BOYAmt |
| EOY | $6,134 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,535 | BOYAmt |
| EOY | $6,651 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,535 | BOYAmt |
| EOY | $6,651 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | Providedentalhygieneservicestolow-incomechildren. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp (6 entries)
| Description Program Srvc AccomDescriptionProgramSrvcAccomTxt | Grants And AllocationsGrantsAndAllocationsAmt | Program Service ExpensesProgramServiceExpensesAmt |
|---|---|---|
| Providedentalhygieneservicestolow-incomechildrenandeducationtoparents guardiansthroughtheDodgeCountyW.I.C.program.Provideddentalcleanings,screenings,fluoride,andoralhealtheducation.Iseeanaverageof30childrenpermonth. | $7,500 | $7,500 |
| TraveltoareaHeadStartClassroomsthreetofourtimesperyeartoprovidescreenings,toothbrushes,floss,andeducationbyvideoandhandsontraining.100childrenandparentsbenefitted. | $1,500 | $1,500 |
| Providedentalhygieneservicestolow-incomechildrenandeducationtoparents guardiansthroughtheSteeleCountyW.I.C.program.Provideddentalcleanings,screenings,fluoride,andoralhealtheducation.Iseeanaverageof50childrenpermonth. | $0 | $8,929 |
| Provide dental hygiene services to low-income children and education to parents guardians through the Waseca County W.I.C. program. Provided dental cleanings screenings fluoride and oral health education. I see an average of 50 children per month. | $8,930 | |
| Provide dental hygiene services to low-income children and education to parents guardians through the Le Sueur County W.I.C. program. Provided dental cleanings screenings fluoride and oral health education. I see an average of 50 children per month. | $8,930 | |
| Provide dental hygiene services to low-income children and education to parents guardians through the Nicollet County W.I.C. program. Provided dental cleanings screenings fluoride and oral health education. I see an average of 50 children per month. | $8,930 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $44,719 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (4 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| Paul Kiltinen | ||||
| Director | 1.00 | $0 | $0 | $0 |
| Amber Converse | ||||
| Secretary | 1.00 | $0 | $0 | $0 |
| Jessica Petefish | ||||
| Vice Chair | 1.00 | $0 | $0 | $0 |
| Shannon Kruckeberg | ||||
| Dental Hygienist | 32.00 | $4,400 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | false | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | false | OrganizationHadUBIInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Form1120 Pol Filed | false | Form1120PolFiledInd |
| Made Loans To From Officers | false | MadeLoansToFromOfficersInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Randy Kruckeberg | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 63407 130TH AVE | AddressLine1Txt |
| City | CLAREMONT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 559244656 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5075282478 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Foreign Office | false | ForeignOfficeInd |
| Donor Advised Fnds | false | DonorAdvisedFndsInd |
| Operate Hospital | false | OperateHospitalInd |
| Tanning Services Provided | false | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| School Operating | false | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (true) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,000 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,000 | CurrentTaxYearAmt |
| Total | $42,000 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $49,623 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $50,492 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $55,202 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,422 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $44,835 | CurrentTaxYearAmt |
| Total | $223,574 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $57,623 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $59,492 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $63,202 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $31,422 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $53,835 | CurrentTaxYearAmt |
| Total | $265,574 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $265,574 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $57,623 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $59,492 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $63,202 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $31,422 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $53,835 | CurrentTaxYearAmt |
| Total | $265,574 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1 | PublicSupportCY509Pct |
| Public Support PY509 | 1.00 | PublicSupportPY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part III - Line 12 | FormAndLineReferenceDesc |
| Explanation | | Year:, Amount:, Description:| 2017, , | 2018, | 2019, | 2020, | 2021, | | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, line 16 | | Other Expenses:, Amount:| Banking Fees, $205| Conferences Conventions and Meetings, $10721| Travel Expenses, $5934| |
| Part II, line 24 | | Explanation:, BOYAmount:, EOYAmount:| No change in mobile equipment assets for the year., $6134, $6134| |