PACIFIC DENTAL SERVICES FOUNDATION: Form 990PF, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PACIFIC DENTAL SERVICES FOUNDATION (EIN 45-5083789)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201603209349100100
- Schema version
- 2015v2.0
- 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
- Form 990-PF
- Schedule B
- Depreciation Schedule
- Land Etc Schedule2
- Other Expenses Schedule
- Other Liabilities Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-14T22:05:12-08:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACIFIC DENTAL SERVICES | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 6107 | AddressLine1Txt |
| City | Norco | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92860 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 455083789 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pacific Dental Services Foundation | BusinessNameLine1Txt |
| Business Name Line2 | FKA PDS Serve Foundation | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PACI | BusinessNameControlTxt |
| Phone | 7148458757 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17000 RED HILL AVENUE | AddressLine1Txt |
| City | IRVINE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92614 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ken Blaisdell | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2016-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Ken Blaisdell | PreparerPersonNm |
| PTIN | P00634226 | PTIN |
| Phone | 7148458680 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $842,995 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $1,530,644 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $626 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $626 | InterestOnSavNetInvstIncmAmt |
| Interest On Savings Adj Net Incm | $626 | InterestOnSavingsAdjNetIncmAmt |
| Total Rev And Expnss | $1,531,270 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $626 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $626 | TotalAdjNetIncmAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $16,625 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $16,625 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Other Prof Fees Rev And Expnss | $5,820 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Dsbrs Chrtbl | $5,820 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $1,994 | TaxesRevAndExpnssAmt |
| Taxes Dsbrs Chrtbl | $1,994 | TaxesDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $57,427 | DeprecAndDpltnRevAndExpnssAmt |
| Trav Conf Meeting Rev And Expnss | $288,040 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $288,040 | TravConfMeetingDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $87,417 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $1,901 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Adj Net Incm | $1,901 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $85,516 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $457,323 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $1,901 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $1,901 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $397,995 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $938,303 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $938,303 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $1,395,626 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $1,901 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $1,901 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $1,336,298 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $135,644 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $233,198 | CashBOYAmt |
| Cash EOY | $452,141 | CashEOYAmt |
| Cash EOYFMV | $452,141 | CashEOYFMVAmt |
| Sav And Temp Cash Invst BOY | $250,730 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $250,418 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $250,418 | SavAndTempCashInvstEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $287,134 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $146,698 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $197,863 | LandBOYAmt |
| Land EOY | $140,436 | LandEOYAmt |
| Land EOYFMV | $140,436 | LandEOYFMVAmt |
| Other Assets BOY | $20,205 | OtherAssetsBOYAmt |
| Total Assets BOY | $701,996 | TotalAssetsBOYAmt |
| Total Assets EOY | $842,995 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $842,995 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $663 | AccountsPayableBOYAmt |
| Other Liabilities BOY | $241,147 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $247,165 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $241,810 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $247,165 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
| Retained Earning BOY | $460,186 | RetainedEarningBOYAmt |
| Retained Earning EOY | $595,830 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $460,186 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $595,830 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $701,996 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $842,995 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $460,186 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $135,644 | ExcessRevenueOverExpensesAmt |
| Subtotal | $595,830 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $595,830 | TotNetAstOrFundBalancesEOYAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $0 | InvestmentIncomeExciseTaxAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | CA | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | Yes (true) | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | pacificdentalservices.com/giving/foundation | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ken Blaisdell | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7148458680 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17000 Red Hill Ave | AddressLine1Txt |
| City | Irvine | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92614 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | false | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | false | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Undistr Incm Sect4942a2 Not App | false | UndistrIncmSect4942a2NotAppInd |
| Business Holdings | false | BusinessHoldingsInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Transactions Fail To Qlfy As Exc | false | TransactionsFailToQlfyAsExcInd |
| Maintained Expenditure Rspns | false | MaintainedExpenditureRspnsInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Proceeds Or Net Income | false | ProceedsOrNetIncomeInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt |
|---|---|---|---|---|---|---|
| STEPHEN THORNE | ||||||
| 1615 Liege Dr | Henderson | NV | 89012 | President | 0.00 | $0 |
| PAMELA THORNE | ||||||
| 1615 Liege Dr | Henderson | NV | 89012 | Secretary | 0.00 | $0 |
| BRADY AASE | ||||||
| 11 DENNIS LANE | LADERA RANCH | CA | 92694 | CFO & Treasurer | 0.00 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | International Communities - providing free dentistry to underserved communities in Guatemala. | Description1Txt |
| Expenses1 | $89,517 | Expenses1Amt |
| Description2 | National Communities - providing oral health grants/scholarships/education; providing encouragement and resources in the areas of relationships, marriages and families. | Description2Txt |
| Expenses2 | $707,365 | Expenses2Amt |
| Description3 | International Communities - providing free dentistry to underserved communities in Fiji. | Description3Txt |
| Expenses3 | $33,740 | Expenses3Amt |
| Description4 | International Communities - providing free dentistry to underserved communities in Ethiopia. | Description4Txt |
| Expenses4 | $125,192 | Expenses4Amt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $0 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $0 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $0 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Adjusted Total FMV Of Unused Ast | $0 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $0 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $0 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $0 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sect4942j3j5 Fndtn And Frgn Org | Yes (X) | Sect4942j3j5FndtnAndFrgnOrgInd |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $1,336,298 | ExpensesAndContributionsAmt |
| Qualifying Distributions | $1,336,298 | QualifyingDistributionsAmt |
| Adjusted Qualifying Distri | $1,336,298 | AdjustedQualifyingDistriAmt |
Private Operating Foundations PrivateOperatingFoundationsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Section4942j3 | Yes (X) | Section4942j3Ind |
Lessor Adj Net Incm Min Invst Ret LessorAdjNetIncmMinInvstRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $0 | CurrentYearAmt |
| Total | $0 | TotalAmt |
Qualifying Distributions QualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $1,336,298 | CurrentYearAmt |
| Year1 | $635,551 | Year1Amt |
| Year2 | $418,187 | Year2Amt |
| Year3 | $239,280 | Year3Amt |
| Total | $2,629,316 | TotalAmt |
Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $1,336,298 | CurrentYearAmt |
| Year1 | $635,551 | Year1Amt |
| Year2 | $418,187 | Year2Amt |
| Year3 | $239,280 | Year3Amt |
| Total | $2,629,316 | TotalAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $842,995 | CurrentYearAmt |
| Year1 | $699,628 | Year1Amt |
| Year2 | $538,712 | Year2Amt |
| Year3 | $144,741 | Year3Amt |
| Total | $2,226,076 | TotalAmt |
Total Assets Sect4942j3 Bi TotalAssetsSect4942j3BiGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $842,995 | CurrentYearAmt |
| Year1 | $699,628 | Year1Amt |
| Year2 | $538,712 | Year2Amt |
| Year3 | $144,741 | Year3Amt |
| Total | $2,226,076 | TotalAmt |
Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Supplementary Information SupplementaryInformationGrp
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | BARBARA VARTANIAN | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17000 RED HILL AVE | AddressLine1Txt |
| City | IRVINE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92614 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 7148458757 | RecipientPhoneNum |
| Recipient Email Address | VARTANIANB@PACDEN.COM | RecipientEmailAddressTxt |
| Form And Info And Materials | APPLICATIONS SHOULD BE SUBMITTED EITHER IN WRITTEN FORM (ON 8.5" X 11") OR BY EMAIL TO VARTANIANB@PACDEN.COM. APPLICATIONS SHOULD INCLUDE - 1) NAME, ADDRESS, TELEPHONE NUMBER AND WEB SITE OF REQUESTING ORGANIZATION2) COPY OF MOST RECENT TWO YEARS' INDEPENDENT AUDITORS' REPORT ON REQUESTING ORGANIZATION, IF AVAILABLE3) A DESCRIPTION OF CHARITABLE ACTIVITIES FOR WHICH GRANT IS REQUESTED, INCLUDING LOCATION4) PERSONS OR CAUSES BENEFITED BY THE ACTIVITIES5) AMOUNT AND DATE(S) OF REQUESTED GRANT(S)6) INFORMATION ABOUT PRIOR CHARITABLE ACTIVITIES OF THE REQUESTING ORGANIZATION7) CONTACT INFORMATION (ADDRESS, PHONE # AND EMAIL) OF INDIVIDUAL SUBMITTING REQUEST | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | AT LEAST 6 MONTHS PROR TO REQUESTED DATE | SubmissionDeadlinesTxt |
| Restrictions On Awards | REQUESTED GRANTS & AWARDS MUST BE CONSISTENT WITH THE FOUNDATION'S CHARITABLE PURPOSE | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (8 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|
| Delarda Cerda | ||||||
| 13970 Dahila Dr | Victorville | CA | 92392 | Individual | To provide dental support to clinicians | $3,000 |
| Storrie Burns | ||||||
| 16672 N Statler Street | Surprise | AZ | 85388 | To provide dental support to clinicians | $2,000 | |
| Staci Lee Smallwood | ||||||
| 3703 Water Birch St | North Las Vegas | NV | 89032 | To provide dental support to clinicians | $2,000 | |
| Randi L Vigna | ||||||
| 11641 Andes St | Reno | NV | 89506 | To provide dental support to clinicians | $2,000 | |
| Daniel J Byrum | ||||||
| 3962 Mississippi St | San Diego | CA | 92104 | To provide dental support to clinicians | $2,000 | |
| Jose P Carpena | ||||||
| 4468 W Sun Quest St | Tucson | AZ | 85741 | To provide dental support to clinicians | $2,000 | |
| Lorena Trejo-Herrera | ||||||
| 45292 Esmerado Ct | Temecula | CA | 92592 | To provide dental support to clinicians | $2,000 | |
| Kelli G Rodriguez | ||||||
| 4004 Spring Green | Pearland | TX | 77584 | To provide dental support to clinicians | $2,000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $17,000 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $626 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | 14 | ExclusionCd |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $626 | UnrelatedBusinessTaxblIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $626 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| General Rule | Yes (X) | GeneralRuleInd |
Contributor Information ContributorInformationGrp (12 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Person ContributionPersonContributionInd |
|---|---|---|---|---|---|---|
| Henry Schein Inc | ||||||
| 1 | 135 Duryea Road | Melville | NY | 11747 | $20,000 | Yes (X) |
| Stephen Thorne | ||||||
| 2 | 1615 Liege Dr | Henderson | NV | 89012 | $50,000 | Yes (X) |
| Pacific Dental Services | ||||||
| 3 | 17000 Red Hill Ave | Irvine | CA | 92614 | $37,500 | Yes (X) |
| Carolyn Ghazal | ||||||
| 4 | 1231 Monte Vista Drive | Redlands | CA | 92373 | $25,000 | Yes (X) |
| Tom Von Sydow | ||||||
| 5 | 21315 Avenida de Arboles | Murrieta | CA | 92562 | $8,000 | Yes (X) |
| Tanisha Jackson | ||||||
| 6 | 734 Strada Casalingo Ct | Redlands | CA | 92373 | $7,000 | Yes (X) |
| David Watkins | ||||||
| 7 | 22 E Placita Vista Campo | Sahuarita | AZ | 85629 | $6,000 | Yes (X) |
| Sirona Dental Inc | ||||||
| 8 | 4835 Sirona Dr Ste 100 | Charlotte | NC | 28273 | $21,000 | Yes (X) |
| Carolyn Ghazal | ||||||
| 9 | 1231 Monte Vista | Redlands | CA | 92373 | $25,000 | Yes (X) |
| Charles Rodgers | ||||||
| 10 | 803 Gainsborough Dr | Laguna Beach | CA | 92651 | $8,000 | Yes (X) |
| Benjamin Poest | ||||||
| 11 | 7106 Meadowood Drive | Austin | TX | 78723 | $8,000 | Yes (X) |
| Dental Trade Alliance Foundation | ||||||
| 12 | 4350 N Fairfax Drive Suite 2 | Arlington | VA | 22203 | $25,000 | Yes (X) |
Depreciation Schedule DepreciationSchedule
Depreciation Property DepreciationPropertyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Property | Transportation Equipment | PropertyDesc |
| Acquired | 2013-07-15 | AcquiredDt |
| Cost Or Other Basis | $287,134 | CostOrOtherBasisAmt |
| Prior Year Depreciation | $88,787 | PriorYearDepreciationAmt |
| Computation Method | SL | ComputationMethodTxt |
| Life | 5.0000 | LifeRt |
| Current Year Expense | $57,427 | CurrentYearExpenseAmt |
Land Etc Schedule2 LandEtcSchedule2
Land Etc LandEtcGrp (2 entries)
| Category Or ItemCategoryOrItemTxt | EOYFMVEOYFMVAmt | Cost Or Other BasisCostOrOtherBasisAmt | Accumulated DepreciationAccumulatedDepreciationAmt | Book ValueBookValueAmt |
|---|---|---|---|---|
| Auto./Transportation Equip. | $140,436 | |||
| Miscellaneous | $287,134 | $146,698 | $140,436 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (12 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt |
|---|---|---|---|---|
| Automobile Expense | $15,008 | $15,008 | ||
| Bank Charges | $1,901 | $1,901 | $1,901 | |
| Computer Expense | $450 | $450 | ||
| Dental Supplies | $396 | $396 | ||
| Education Expense | $190 | $190 | ||
| Equipment Rental | $61 | $61 | ||
| Liability Expense | $33,104 | $33,104 | ||
| License & Permits | $3,400 | $3,400 | ||
| Office Expense | $14,679 | $14,679 | ||
| Postage | $8,759 | $8,759 | ||
| Promo | $6,426 | $6,426 | ||
| Storage Fees | $3,043 | $3,043 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail (2 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt |
|---|---|---|
| Due To Affiliates | $241,147 | $250,472 |
| OTHER | -$3,307 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | Consulting | CategoryTxt |
| Amt | $5,820 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $5,820 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|
| FTB | $72 | $72 |
| Payroll | $1,922 | $1,922 |