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PIEDMONT VIRGINIA DENTAL HEALTH FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
PIEDMONT VIRGINIA DENTAL HEALTH FOUNDATION (EIN 20-1468244)
Tax period
2011-07-01 to 2012-06-30
Filed
2012-10-04
IRS object ID
201222789349300227
Schema version
2011v1.2
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)
Timestamp2012-10-04T12:21:45-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN541681507EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Sells Hogg & Associates CPAs PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11079 Spruce Street Suite BAddressLine1
CityMartinsvilleCity
StateVAState
ZIP Code24112ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN201468244EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Piedmont Virginia Dental Health FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPIEDNameControl
Phone2766329266Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1407 Starling AvenueAddressLine1
CityMartinsvilleCity
StateVAState
ZIP Code241123731ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMark A Crabtree DDSName
TitlePresidentTitle
Phone2766329266Phone
Date Signed2012-10-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRobert W Hogg CPAName
PTINP00006336PTIN
Phone2766383904Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMark A Crabtree DDSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1407 Starling AveAddressLine1
CityMartinsvilleCity
StateVAState
ZIP Code24112ZIPCode
FieldValueIRS element (for citing)
Gross Receipts332845GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization OtherXTypeOfOrganizationOther
Type Of Org Other DescriptionFoundationTypeOfOrgOtherDescription
Year Formation2004YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionTo operate a dental clinic to provide free and reduced-fee dental services to unemployed and uninsured adults, needy children and Medicaid patients who have been unable to acquire such servicesActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees7TotalNbrEmployees
Total Nbr Volunteers30TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year54333ContributionsGrantsPriorYear
Contributions Grants Current Year99945ContributionsGrantsCurrentYear
Program Service Revenue Prior Year246362ProgramServiceRevenuePriorYear
Program Service Revenue CY232567ProgramServiceRevenueCY
Investment Income Prior Year612InvestmentIncomePriorYear
Investment Income Current Year333InvestmentIncomeCurrentYear
Other Revenue Prior Year733OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year302040TotalRevenuePriorYear
Total Revenue Current Year332845TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year255787SalariesEtcPriorYear
Salaries Etc Current Year256891SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year147492OtherExpensePriorYear
Other Expenses Current Year147885OtherExpensesCurrentYear
Total Expenses Prior Year403279TotalExpensesPriorYear
Total Expenses Current Year404776TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-101239RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-71931RevenuesLessExpensesCY
Total Assets BOY187631TotalAssetsBOY
Total Assets EOY115659TotalAssetsEOY
Total Liabilities BOY6923TotalLiabilitiesBOY
Total Liabilities EOY6882TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY180708NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY108777NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe Foundation's mission is to operate a dental clinic to improve the oral health of the community's disadvantaged citizens through oral health education and dental and dental hygiene services. The clinic's patient care goal is to provide the maximum amount of access to dental care for our unissured, unemployed and low-income population. Its externship goal is to provide VCU dental students (externs) with a real-life, general dentistry, private practice experience in a state of the art dental facility.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense395592Expense
Revenue232567Revenue
DescriptionThe Foundation operates a dental clinic staffed by a dentist and students from the Virginia Commonwealth University School of Dentistry. The dental students are supervised by the dentist and volunteer local area practicing dentists. Free or reduced-fee dental services were provided to needy indivuals.Description
Total Program Service Expense395592TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees7NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMark A Crabtree DDSNamePerson
Telephone Number2766329266TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1407 Starling AvenueAddressLine1
CityMartinsvilleCity
StateVAState
ZIP Code24112ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Mark A Crabtree DDS
President/Director7.00XX000
Edward P Snyder DDS
Vice-Pres/Director1.00XX000
Ann C Huffman
Sec/Treas/Director4.00XX1380000
M Gene Teague
Director1.00X000
Paul R Eason MD
Director1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org13800TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions99945AllOtherContributions
Total Contributions99945TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Dental fees - Medicaid812900155311155311
Dental fees - patients8129007129671296
DATS program90009954005400
Boys and Girls Club900099560560
FieldValueIRS element (for citing)
Total Program Service Revenue232567TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column333TotalRevenueColumn
Exclusion$333ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column332845TotalRevenueColumn
Related Or Exempt Function Income232567RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$333ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total13800Total
Program Services9200ProgramServices
Management And General4600ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total201081Total
Program Services201081ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total5165Total
Program Services5165ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total20501Total
Program Services20406ProgramServices
Management And General95ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total16344Total
Program Services16344ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total960Total
Program Services960ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total848Total
Program Services848ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5562Total
Program Services5006ProgramServices
Management And General556ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total9505Total
Program Services8554ProgramServices
Management And General951ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total30299Total
Program Services30299ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1859Total
Program Services1859ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total17379Total
Program Services17379ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total945Total
Program Services945ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Dental supplies4457644576
Rent13381120431338
Meals for students50945094
Uniform allowance42754275

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13202Total
Program Services11558ProgramServices
Management And General1644ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total404776Total
Program Services395592ProgramServices
Management And General9184ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY10019BOY
EOY-3106EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY59131BOY
EOY4031EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY16695BOY
EOY20105EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis194300LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec99671LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY101786BOY
EOY94629EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY187631BOY
EOY115659EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6923BOY
EOY6882EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6923BOY
EOY6882EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY180708BOY
EOY108777EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY180708BOY
EOY108777EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY187631BOY
EOY115659EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-71931ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years63504CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years133931CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years136310CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year54333CurrentTaxYearMinus1Year
Current Tax Year99945CurrentTaxYear
Total488023Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years123001CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years171919CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years240291CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year246362CurrentTaxYearMinus1Year
Current Tax Year232567CurrentTaxYear
Total1014140Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years186505CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years305850CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years376601CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year300695CurrentTaxYearMinus1Year
Current Tax Year332512CurrentTaxYear
Total1502163Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total5091502163PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2126CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1245CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years866CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year612CurrentTaxYearMinus1Year
Current Tax Year333CurrentTaxYear
Total5182Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2126CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1245CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years866CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year612CurrentTaxYearMinus1Year
Current Tax Year333CurrentTaxYear
Total5182Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years188631CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years307095CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years377467CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year301307CurrentTaxYearMinus1Year
Current Tax Year332845CurrentTaxYear
Total1507345Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99660PublicSupportPercentage509
Prior Year Support Percentage0.99510PriorYearSupportPercentage
Investment Income Percentage0.00340InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00490PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis129675OtherCostOrOtherBasis
Depreciation47878Depreciation
Book Value81797BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis64625OtherCostOrOtherBasis
Depreciation51793Depreciation
Book Value12832BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings94629TotalOfBookValueLandBuildings

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Section B, line 11The Foundation provides a copy of return for review at board of directors meeting before filing.
Form 990, Part VI, Section C, line 19The Foundation makes its governing documents, conflict of interest policy, and financial statments available to the public upon request, either for viewing in the Foundation's office or providing copies to the requester.