TOLOSA CHILDRENS DENTAL CENTER: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- TOLOSA CHILDRENS DENTAL CENTER (EIN 77-0346861)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-01-25
- IRS object ID
- 202210259349301576
- Schema version
- 2020v4.1
- 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 | 2022-01-25T15:07:20-06:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 262350873 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALIBER AUDIT & ATTEST LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 AEROVISTA PLACE SUITE 103 | AddressLine1Txt |
| City | SAN LUIS OBISPO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770346861 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TOLOSA CHILDREN'S DENTAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TOLO | BusinessNameControlTxt |
| Phone | 8052385334 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 717 WALNUT DRIVE | AddressLine1Txt |
| City | PASO ROBLES | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93446 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JON HOLLISTER | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 8052385334 | PhoneNum |
| Signature | 2022-01-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JON | PersonFirstNm |
| Person Last | HOLLISTER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KIMBERLYN SPILLER CPA | PreparerPersonNm |
| PTIN | P01491937 | PTIN |
| Phone | 8058880200 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JON HOLLISTER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 717 WALNUT DRIVE | AddressLine1Txt |
| City | PASO ROBLES | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93446 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,756,555 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | TOLOSACHILDRENSDENTAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE DENTAL SERVICES FOR UNDERPRIVILEGED CHILDREN IN SAN LUIS OBISPO COUNTY | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 31 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $233,563 | PYContributionsGrantsAmt |
| CY Contributions Grants | $645,347 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,569,718 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,094,831 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,659 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,577 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$538 | PYOtherRevenueAmt |
| CY Other Revenue | -$14,376 | CYOtherRevenueAmt |
| PY Total Revenue | $1,808,402 | PYTotalRevenueAmt |
| CY Total Revenue | $1,729,379 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,157,527 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,033,217 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $84,105 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $474,254 | PYOtherExpensesAmt |
| CY Other Expenses | $361,166 | CYOtherExpensesAmt |
| PY Total Expenses | $1,631,781 | PYTotalExpensesAmt |
| CY Total Expenses | $1,394,383 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $176,621 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $334,996 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,440,817 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,584,715 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $283,095 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $91,997 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,157,722 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,492,718 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE DENTAL SERVICES FOR UNDERPRIVILEGED CHILDREN IN SAN LUIS OBISPO COUNTY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,152,695 | ExpenseAmt |
| Revenue | $1,094,722 | RevenueAmt |
| Desc | TO PROVIDE DENTAL SERVICES TO UNDERPRIVILEDGED CHILDREN IN SAN LUIS OBISPO COUNTY. PRODUCTION PROGRAM REVENUE IS DERIVED MAINLY FROM DENTI-CAL REIMBURSEMENTS AND IS REPORTED NET OF CLAIMS ADJUSTMENTS. | Desc |
| Total Program Service Expenses | $1,152,695 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 31 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SUZANNE RUSSELL | PersonNm |
| Phone | 8052382216 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 717 WALNUT DRIVE | AddressLine1Txt |
| City | PASO ROBLES | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93446 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| JON HOLLISTER DDS | ||||||||
| PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JAMES TEDFORD MD | ||||||||
| VICE PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SCOTT MILSTEAD | ||||||||
| TREASURER/SECRETARY | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MARTY CRAVEN MD DDS | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CHUCK BRAUN | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBYN FLORES DMD | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| LAURIE TORGERSON | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| HEIDI WILLIAMS | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KRISTIN KEARNS | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| NICOLE RADAKOVICH | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| SHAUNA HAYES DMD | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| SUZANNE RUSSELL | ||||||||
| EXECUTIVE DIRECTOR | 50.00 | Yes (X) | $85,679 | $0 | $8,276 | |||
| ALEXANDRA CHAMBERLAIN | ||||||||
| DIRECTOR OF DEVELOPMENT | 40.00 | Yes (X) | $45,789 | $0 | $1,560 | |||
| THOMAS NAKATSUCHI DDS | ||||||||
| EMPLOYEE-DENTIST | 40.00 | $116,439 | $0 | $12,476 | Yes (X) | |||
| RACHEL WILLIAMS | ||||||||
| EMPLOYEE-DENTIST - FORMER | 40.00 | $109,918 | $0 | $0 | Yes (X) | |||
| MARTIN DUNNE DDS | ||||||||
| EMPLOYEE-DENTIST - FORMER | 32.00 | $41,202 | $0 | $0 | Yes (X) | |||
| KIM TRINH | ||||||||
| EMPLOYEE-DENTIST - FORMER | 40.00 | $99,905 | $0 | $0 | Yes (X) | |||
| JU LAWRENCE | ||||||||
| EMPLOYEE-DENTIST - FORMER | 24.00 | $0 | $0 | $0 | Yes (X) | |||
| ANDREA N LIVINGOOD DDS | ||||||||
| EMPLOYEE-DENTIST - FORMER | 40.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $498,932 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $22,312 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $56,097 | FundraisingAmt |
| Government Grants | $482,720 | GovernmentGrantsAmt |
| All Other Contributions | $106,530 | AllOtherContributionsAmt |
| Noncash Contributions | $8,355 | NoncashContributionsAmt |
| Total Contributions | $645,347 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PRODUCTION PROGRAM REV | 621300 | $1,088,427 | $1,088,427 |
| DTI INCENTIVES | 621300 | $6,404 | $6,404 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,094,831 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,891 | TotalRevenueColumnAmt |
| Exclusion | $3,891 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $314 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$314 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$314 | TotalRevenueColumnAmt |
| Exclusion | -$314 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $12,595 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $56,097 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $26,862 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$14,267 | TotalRevenueColumnAmt |
| Exclusion | -$14,267 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 713990 | BusinessCd |
| Total Revenue Column | -$109 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$109 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$109 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,729,379 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,094,722 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$10,690 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,211 | TotalAmt |
| Management And General | $92,582 | ManagementAndGeneralAmt |
| Fundraising | $56,629 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $767,593 | TotalAmt |
| Program Services | $767,593 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,771 | TotalAmt |
| Program Services | $12,669 | ProgramServicesAmt |
| Management And General | $1,102 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,969 | TotalAmt |
| Program Services | $33,614 | ProgramServicesAmt |
| Management And General | $2,355 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,673 | TotalAmt |
| Program Services | $57,339 | ProgramServicesAmt |
| Management And General | $5,334 | ManagementAndGeneralAmt |
| Fundraising | $4,000 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,855 | TotalAmt |
| Program Services | $498 | ProgramServicesAmt |
| Management And General | $7,276 | ManagementAndGeneralAmt |
| Fundraising | $81 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,150 | TotalAmt |
| Management And General | $3,150 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,555 | TotalAmt |
| Management And General | $23,555 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,750 | TotalAmt |
| Program Services | $3,750 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,622 | TotalAmt |
| Fundraising | $10,622 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,366 | TotalAmt |
| Program Services | $5,980 | ProgramServicesAmt |
| Management And General | $221 | ManagementAndGeneralAmt |
| Fundraising | $165 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,938 | TotalAmt |
| Program Services | $19,488 | ProgramServicesAmt |
| Management And General | $6,450 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,556 | TotalAmt |
| Program Services | $38,556 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,386 | TotalAmt |
| Program Services | $63,972 | ProgramServicesAmt |
| Management And General | $5,951 | ManagementAndGeneralAmt |
| Fundraising | $4,463 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,604 | TotalAmt |
| Program Services | $19,440 | ProgramServicesAmt |
| Management And General | $1,808 | ManagementAndGeneralAmt |
| Fundraising | $1,356 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| DENTAL SUPPLIES | $75,438 | $75,438 | ||
| REPAIRS | $15,098 | $15,098 | ||
| OUTSIDE SERVICE | $9,162 | $7,590 | $1,052 | $520 |
| DUES | $6,261 | $6,261 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,425 | TotalAmt |
| Program Services | $25,409 | ProgramServicesAmt |
| Management And General | $6,747 | ManagementAndGeneralAmt |
| Fundraising | $6,269 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,394,383 | TotalAmt |
| Program Services | $1,152,695 | ProgramServicesAmt |
| Management And General | $157,583 | ManagementAndGeneralAmt |
| Fundraising | $84,105 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $510,079 | BOYAmt |
| EOY | $1,845,394 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $854,249 | BOYAmt |
| EOY | $155,861 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,720 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $515,374 | BOYAmt |
| EOY | $75,673 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,758 | BOYAmt |
| EOY | $13,948 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $973,305 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $479,466 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $530,637 | BOYAmt |
| EOY | $493,839 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,440,817 | BOYAmt |
| EOY | $2,584,715 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,949 | BOYAmt |
| EOY | $81,697 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $10,300 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,146 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $283,095 | BOYAmt |
| EOY | $91,997 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,157,722 | BOYAmt |
| EOY | $2,492,718 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,157,722 | BOYAmt |
| EOY | $2,492,718 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,440,817 | BOYAmt |
| EOY | $2,584,715 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $334,996 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $198,208 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $182,202 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $305,106 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $252,884 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $229,876 | CurrentTaxYearAmt |
| Total | $1,168,276 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $198,208 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $182,202 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $305,106 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $252,884 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $229,876 | CurrentTaxYearAmt |
| Total | $1,168,276 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,168,276 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,852 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,888 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,873 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,659 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,892 | CurrentTaxYearAmt |
| Total | $19,164 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,187,440 | TotalSupportAmt |
| Public Support CY170 | 0.98390 | PublicSupportCY170Pct |
| Public Support PY170 | 0.98550 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $448,950 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $127,578 | DepreciationAmt |
| Book Value | $321,372 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $524,355 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $351,888 | DepreciationAmt |
| Book Value | $172,467 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $493,839 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S ACTIVITIES ARE GENERALLY EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SECTION 23701(D) OF THE CALIFORNIA FRANCHISE TAX CODE. SINCE THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAX LIABILITY, NO PROVISION IS MADE FOR CURRENT OR DEFERRED INCOME TAX EXPENSE. THE ORGANIZATION IS NOT A PRIVATE FOUNDATION. MANAGEMENT IS NOT AWARE OF ANY TRANSACTIONS THAT WOULD IMPACT THE ORGANIZATION'S TAX-EXEMPT STATUS. FOR THE YEAR ENDED JUNE 30, 2021, MANAGEMENT OF THE ORGANIZATION IS NOT AWARE OF ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE ACCOUNTED FOR IN THE FINANCIAL STATEMENTS UNDER THE PRINCIPLES OF THE INCOME TAXES TOPIC OF THE FASB (ASC). THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE. ALL TAX EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE AND OTHER APPLICABLE AGENCIES. SUCH AGENCIES MAY REVIEW THE TAXABILITY OF UNRELATED BUSINESS INCOME, OR THE QUALIFICATION OF THE TAX-EXEMPT ENTITY UNDER THE INTERNAL REVENUE CODE AND APPLICABLE STATE STATUTES. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | ANNUAL APPEAL | Event1Nm |
| Gross Receipts Event1 | $37,465 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $37,465 | CharitableContriEvent1Amt |
| Other Direct Expenses Event1 | $5,555 | OtherDirectExpensesEvent1Amt |
| Event2 | SIP FOR SMILES | Event2Nm |
| Gross Receipts Event2 | $31,227 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $18,632 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $12,595 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $6,092 | NonCashPrizesEvent2Amt |
| Food And Beverage Event2 | $3,000 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $1,500 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $9,920 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Oth Direct Expnss Other Events | $795 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $68,692 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $56,097 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $12,595 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $6,092 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $3,000 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $1,500 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $16,270 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $26,862 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$14,267 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS NAKATSUCHI DDS | ||||||||||||||
| EMPLOYEE-DENTIST | $116,439 | $0 | $0 | $0 | $0 | $0 | $6,900 | $0 | $5,576 | $0 | $128,915 | $0 | $0 | $0 |
| RACHEL WILLIAMS | ||||||||||||||
| EMPLOYEE-DENTIST - FORMER | $109,918 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $109,918 | $0 | $0 | $0 |
| KIM TRINH | ||||||||||||||
| EMPLOYEE-DENTIST - FORMER | $99,905 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $99,905 | $0 | $0 | $0 |
| SUZANNE RUSSELL | ||||||||||||||
| EXECUTIVE DIRECTOR | $85,679 | $0 | $0 | $0 | $0 | $0 | $2,700 | $0 | $5,576 | $0 | $93,955 | $0 | $0 | $0 |
| ALEXANDRA CHAMBERLAIN | ||||||||||||||
| DIRECTOR OF DEVELOPMENT | $45,789 | $0 | $0 | $0 | $0 | $0 | $1,560 | $0 | $0 | $0 | $47,349 | $0 | $0 | $0 |
| MARTIN DUNNE DDS | ||||||||||||||
| EMPLOYEE-DENTIST - FORMER | $41,202 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $41,202 | $0 | $0 | $0 |
| JU LAWRENCE | ||||||||||||||
| EMPLOYEE-DENTIST - FORMER | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| ANDREA N LIVINGOOD DDS | ||||||||||||||
| EMPLOYEE-DENTIST - FORMER | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | KEY OFFICERS OF THE ORGANIZATION REVIEW THE TAX RETURN BEFORE SIGNING AND FILING |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS MONITORED ANNUALLY AND INTERESTED PARTIES WOULD REPORT ANY POTENTIAL CONFLICTS AS THEY SHOULD ARISE. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION PROCESS FOR TOP OFFICIAL: THE EXECUTIVE COMMITTEE PERFORMS AN ANNUAL REVIEW AND SALARY REVIEW FOR THE ORGANIZATION'S EXECUTIVE DIRECTOR. |
| FORM 990, PART VI, SECTION C, LINE 18 | DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FOR PUBLIC INSPECTION VIA MONTHLY PUBLIC BOARD MEETINGS AND UPON REQUEST. |