DENTAL PATIENT SAFETY FOUNDATION: Form 990PF, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: DENTAL PATIENT SAFETY FOUNDATION (EIN 82-2245000)
Tax period: 2021-07-01 to 2022-06-30
Filed: 2022-08-15
IRS object ID: 202222319349100902
Schema version: 2021v4.2
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
Form 990-PF
Schedule B
Accounting Fees Schedule
Other Expenses Schedule
Substantial Contributors Sch

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-08-15T05:04:44-00:00	ReturnTs
Tax Period End	2022-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	363863792	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Ronald B Bosack PC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	405 N Oak Ave	AddressLine1Txt
City	Mount Prospect	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60056	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990PF	ReturnTypeCd
Tax Period Begin	2021-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	822245000	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DENTAL PATIENT SAFETY FOUNDATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	DENT	BusinessNameControlTxt
Phone	8332167931	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	16011 SOUTH 108TH AVENUE	AddressLine1Txt
City	ORLAND PARK	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60467	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ROBERT C BOSACK	PersonNm
Person Title	PRESIDENT	PersonTitleTxt
Phone	8332167931	PhoneNum
Signature	2022-08-15	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	ROBERT	PersonFirstNm
Person Last	BOSACK	PersonLastNm

Field	Value	IRS element (for citing)
SSN	XXX-XX-XXXX	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Ronald B Bosack	PreparerPersonNm
PTIN	P01254658	PTIN
Phone	8476449300	PhoneNum
Preparation	2022-08-15	PreparationDt

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	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990-PF IRS990PF

Field	Value	IRS element (for citing)
Organization501c3 Exempt PF	Yes (X)	Organization501c3ExemptPFInd
FMV Assets EOY	$52,950	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	$17,000	ContriRcvdRevAndExpnssAmt
Cap Gain Net Incm Net Invst Incm	$0	CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss	$17,000	TotalRevAndExpnssAmt
Total Net Invst Incm	$0	TotalNetInvstIncmAmt
Accounting Fees Rev And Expnss	$1,335	AccountingFeesRevAndExpnssAmt
Other Expenses Rev And Expnss	$7,218	OtherExpensesRevAndExpnssAmt
Other Expenses Dsbrs Chrtbl	$3,314	OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss	$8,553	TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm	$0	TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl	$3,314	TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss	$0	ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl	$0	ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss	$8,553	TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm	$0	TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl	$3,314	TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses	$8,447	ExcessRevenueOverExpensesAmt
Net Investment Income	$0	NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

Field	Value	IRS element (for citing)
Cash BOY	$44,503	CashBOYAmt
Cash EOY	$52,950	CashEOYAmt
Cash EOYFMV	$52,950	CashEOYFMVAmt
Total Assets BOY	$44,503	TotalAssetsBOYAmt
Total Assets EOY	$52,950	TotalAssetsEOYAmt
Total Assets EOYFMV	$52,950	TotalAssetsEOYFMVAmt
Total Liabilities EOY	$0	TotalLiabilitiesEOYAmt
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY	$44,503	NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY	$52,950	NoDonorRstrNetAssestsEOYAmt
Tot Net Ast Or Fund Balances BOY	$44,503	TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY	$52,950	TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY	$44,503	TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY	$52,950	TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

Field	Value	IRS element (for citing)
Tot Net Ast Or Fund Balances BOY	$44,503	TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses	$8,447	ExcessRevenueOverExpensesAmt
Subtotal	$52,950	SubtotalAmt
Tot Net Ast Or Fund Balances EOY	$52,950	TotNetAstOrFundBalancesEOYAmt

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
Organization Dissolved Etc	false	OrganizationDissolvedEtcInd
At Least5000 In Assets	Yes (true)	AtLeast5000InAssetsInd
Org Report Or Register State	IL	OrgReportOrRegisterStateCd
Form990 PF Filed With Atty Gen	Yes (true)	Form990PFFiledWithAttyGenInd
Private Operating Foundation	Yes (true)	PrivateOperatingFoundationInd
New Substantial Contributors	Yes (true)	NewSubstantialContributorsInd
Own Controlled Entity	false	OwnControlledEntityInd
Donor Advised Fund	false	DonorAdvisedFundInd
Comply With Public Insp Rqr	Yes (true)	ComplyWithPublicInspRqrInd
Website Address	WWW.DENTALPATIENTSAFETY.ORG	WebsiteAddressTxt
Individual With Books	ROBERT C BOSACK	IndividualWithBooksNm
Phone	8332167931	PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

Field	Value	IRS element (for citing)
Address Line1	16011 S 108TH AVE	AddressLine1Txt
City	ORLAND PARK	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60467	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
Uncorrected Prior Acts	false	UncorrectedPriorActsInd
Undistributed Income PY	false	UndistributedIncomePYInd
Business Holdings	false	BusinessHoldingsInd
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
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
Subj To Tax Rmnrtn Ex Prcht Pymt	false	SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	TitleTitleTxt	Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt	CompensationCompensationAmt
ROBERT BOSACK
16011 S 108TH AVE	ORLAND PARK	IL	60467	DIRECTOR	000.00	$0
MICHAEL ROLLERT
6850 E HAMPDEN AVE	DENVER	CO	80224	DIRECTOR	000.00	$0
STUART LIEBLICH
34 DALE ROAD SUITE 105	AVON	CT	06001	DIRECTOR	000.00	$0
JOSEPH A GIOVANNITTI JR
198 DELAWARE TRAIL	VENETIA	PA	15367	DIRECTOR	000.00	$0
STEVEN PATRICK GEIERMANN
5218 N WINTHROP AVE 3N	CHICAGO	IL	60640	DIRECTOR	000.00	$0

Field	Value	IRS element (for citing)
Comp Of Hghst Pd Cntrct Or NONE	NONE	CompOfHghstPdCntrctOrNONETxt

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

Field	Value	IRS element (for citing)
Description1	MAINTAIN AND ENHANCE WEBSITE FOR DATA COLLECTION AND ACCESS BY DENTAL COMMUNITY	Description1Txt
Expenses1	$3,314	Expenses1Amt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

Field	Value	IRS element (for citing)
Description1	N/A	Description1Txt

Minimum Investment Return MinimumInvestmentReturnGrp

Field	Value	IRS element (for citing)
Average Monthly FMV Of Sec	$0	AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances	$43,853	AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast	$0	FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets	$43,853	TotalFMVOfUnusedAssetsAmt
Adjusted Total FMV Of Unused Ast	$43,853	AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable	$658	CashDeemedCharitableAmt
Net Vl Noncharitable Assets	$43,195	NetVlNoncharitableAssetsAmt
Minimum Investment Return	$2,160	MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

Field	Value	IRS element (for citing)
Minimum Investment Return	$2,160	MinimumInvestmentReturnAmt
Distributable Before Adj	$2,160	DistributableBeforeAdjAmt
Distributable Before Ded	$2,160	DistributableBeforeDedAmt
Distributable As Adjusted	$2,160	DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

Field	Value	IRS element (for citing)
Expenses And Contributions	$3,314	ExpensesAndContributionsAmt
Qualifying Distributions	$3,314	QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

Field	Value	IRS element (for citing)
Distributable As Adjusted	$2,160	DistributableAsAdjustedAmt
Excess Distribution Cyov Yr4	$3,675	ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3	$11,037	ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2	$1,380	ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1	$1,123	ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov	$17,215	TotalExcessDistributionCyovAmt
Qualifying Distributions	$3,314	QualifyingDistributionsAmt
Applied To Current Year	$2,160	AppliedToCurrentYearAmt
Remaining Distri From Corpus	$1,154	RemainingDistriFromCorpusAmt
Total Corpus	$18,369	TotalCorpusAmt
Undistributed Income CY	$0	UndistributedIncomeCYAmt
Excess Distri Cyov To Next Yr	$18,369	ExcessDistriCyovToNextYrAmt
Excess From Year4	$3,675	ExcessFromYear4Amt
Excess From Year3	$11,037	ExcessFromYear3Amt
Excess From Year2	$1,380	ExcessFromYear2Amt
Excess From Year1	$1,123	ExcessFromYear1Amt
Excess From Current Year	$1,154	ExcessFromCurrentYearAmt

Private Operating Foundations PrivateOperatingFoundationsGrp

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	$3,314	CurrentYearAmt
Year1	$3,459	Year1Amt
Year2	$3,296	Year2Amt
Year3	$12,609	Year3Amt
Total	$22,678	TotalAmt

Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp

Field	Value	IRS element (for citing)
Current Year	$3,314	CurrentYearAmt
Year1	$3,459	Year1Amt
Year2	$3,296	Year2Amt
Year3	$12,609	Year3Amt
Total	$22,678	TotalAmt

Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp

Field	Value	IRS element (for citing)
Current Year	$1,440	CurrentYearAmt
Year1	$1,557	Year1Amt
Year2	$1,277	Year2Amt
Year3	$1,048	Year3Amt
Total	$5,322	TotalAmt

Supplementary Information SupplementaryInformationGrp

Field	Value	IRS element (for citing)
Contributing Manager	NONE	ContributingManagerNm
Shareholder Manager	NONE	ShareholderManagerNm
Only Contri To Preselected	Yes (X)	OnlyContriToPreselectedInd

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

Field	Value	IRS element (for citing)
Contributor	1	ContributorNum
Contributor Person	NATIONAL DENTAL BOARD OF ANESTHESIO	ContributorPersonNm

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	211 E CHICAGO AVE STE 380	AddressLine1Txt
City	CHICAGO	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60611	ZIPCd

Field	Value	IRS element (for citing)
Total Contributions	$10,000	TotalContributionsAmt
Person Contribution	Yes (X)	PersonContributionInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

Field	Value	IRS element (for citing)
Category	ACCOUNTING FEES	CategoryTxt
Amt	$1,335	Amt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)

DescDesc	Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt	Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt
LICENSES AND FEES	$25
MARKETING AND WEB SITE EXPENSES	$6,628	$3,314
MERCHANT SERVICE CC FEES	$565

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd
ANESTHESIA RESEARCH FOUNDATION
211 EAST CHICAGO AVE STE 1720	CHICAGO	IL	60611
AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS
9700 W BRYN MAWR AVE	ROSEMONT	IL	60018
FLORIDA DENTAL SOCIETY OF ANESTHESIOLOGY
PO BOX 444	ORANGE PARK	FL	32067

DENTAL PATIENT SAFETY FOUNDATION: Form 990PF, tax year 2021

Return header ReturnHeader

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Preparer US Address PreparerUSAddress

Filer Filer

Business Name BusinessName

US Address USAddress

Business Officer BusinessOfficerGrp

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Preparer Person PreparerPersonGrp

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Form 990-PF IRS990PF

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

Statements Regarding Acty StatementsRegardingActyGrp

Location Of Books US Address LocationOfBooksUSAddress

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (5 entries)

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

Minimum Investment Return MinimumInvestmentReturnGrp

Distributable Amount DistributableAmountGrp

PF Qualifying Distributions PFQualifyingDistributionsGrp

Undistributed Income UndistributedIncomeGrp

Private Operating Foundations PrivateOperatingFoundationsGrp

Lessor Adj Net Incm Min Invst Ret LessorAdjNetIncmMinInvstRetGrp

Qualifying Distributions QualifyingDistributionsGrp

Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp

Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp

Supplementary Information SupplementaryInformationGrp

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Contributor US Address ContributorUSAddress

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail (3 entries)

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