DENTAL PATIENT SAFETY FOUNDATION: Form 990PF, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- DENTAL PATIENT SAFETY FOUNDATION (EIN 82-2245000)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2020-12-08
- IRS object ID
- 202023439349101102
- Schema version
- 2019v5.1
- 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
- Form 990-PF
- Schedule B
- Accounting Fees Schedule
- Other Expenses Schedule
- Substantial Contributors Sch
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-12-08T09:45:29-00:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
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 | 2019-07-01 | 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 BOSACK | PersonNm |
| Person Title | CHAIRMAN | PersonTitleTxt |
| Phone | 8332167931 | PhoneNum |
| Signature | 2020-12-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Ronald B Bosack | PreparerPersonNm |
| Phone | 8476449300 | PhoneNum |
| Preparation | 2020-12-08 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 64.53.129.178 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-12-08 | IPDt |
| IP Tm | 17:14:44 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 0648105AC80FA720C8EFBBCD849DD960B8B60668 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 0648105AC80FA720C8EFBBCD849DD960B8B60668 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-04-22 16:20:28Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $50,295 | 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 | $21,750 | ContriRcvdRevAndExpnssAmt |
| Cap Gain Net Incm Net Invst Incm | $0 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $21,750 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $0 | TotalNetInvstIncmAmt |
| Accounting Fees Rev And Expnss | $1,350 | AccountingFeesRevAndExpnssAmt |
| Other Expenses Rev And Expnss | $7,342 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Dsbrs Chrtbl | $3,296 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $8,692 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $3,296 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $0 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $0 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $8,692 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $3,296 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $13,058 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $37,237 | CashBOYAmt |
| Cash EOY | $50,295 | CashEOYAmt |
| Cash EOYFMV | $50,295 | CashEOYFMVAmt |
| Total Assets BOY | $37,237 | TotalAssetsBOYAmt |
| Total Assets EOY | $50,295 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $50,295 | TotalAssetsEOYFMVAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $37,237 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $50,295 | NoDonorRstrNetAssestsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $37,237 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $50,295 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $37,237 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $50,295 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $37,237 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $13,058 | ExcessRevenueOverExpensesAmt |
| Subtotal | $50,295 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $50,295 | TotNetAstOrFundBalancesEOYAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Adjusted Qlfy Distri Yr1 | $12,609 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $31,431 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 000000.401164 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $4,641 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $19,311 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 000000.240329 | DistributionYr2Rt |
| Total Distribution | 000000.641493 | TotalDistributionRt |
| Average Distribution | 000000.128299 | AverageDistributionRt |
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 |
| 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 | false | 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 |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
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 |
| JASON BRADY | ||||||
| 3343 E INDIGO BAY CT | GILBERT | AZ | 85234 | DIRECTOR | 000.00 | $0 |
| ROY STEVENS | ||||||
| 8283 SOUTH WALKER AVE STE B | OKLAHOMA CITY | OK | 73139 | 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 | $6,592 | 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 | $38,906 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $38,906 | TotalFMVOfUnusedAssetsAmt |
| Adjusted Total FMV Of Unused Ast | $38,906 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $584 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $38,322 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $1,916 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $1,916 | MinimumInvestmentReturnAmt |
| Distributable Before Adj | $1,916 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $1,916 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $1,916 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $3,296 | ExpensesAndContributionsAmt |
| Qualifying Distributions | $3,296 | QualifyingDistributionsAmt |
| Adjusted Qualifying Distri | $3,296 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $1,916 | DistributableAsAdjustedAmt |
| Excess Distribution Cyov Yr2 | $3,675 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $11,037 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $14,712 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $3,296 | QualifyingDistributionsAmt |
| Applied To Current Year | $1,916 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $1,380 | RemainingDistriFromCorpusAmt |
| Total Corpus | $16,092 | TotalCorpusAmt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $16,092 | ExcessDistriCyovToNextYrAmt |
| Excess From Year2 | $3,675 | ExcessFromYear2Amt |
| Excess From Year1 | $11,037 | ExcessFromYear1Amt |
| Excess From Current Year | $1,380 | 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 | $3,296 | CurrentYearAmt |
| Year1 | $12,609 | Year1Amt |
| Year2 | $4,641 | Year2Amt |
| Total | $20,546 | TotalAmt |
Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $3,296 | CurrentYearAmt |
| Year1 | $12,609 | Year1Amt |
| Year2 | $4,641 | Year2Amt |
| Total | $20,546 | TotalAmt |
Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $1,277 | CurrentYearAmt |
| Year1 | $1,048 | Year1Amt |
| Year2 | $644 | Year2Amt |
| Total | $2,969 | 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 (3 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Person ContributionPersonContributionInd |
|---|---|---|---|---|---|---|
| AMERICAN DENTAL SOCIETY OF ANESTHES | ||||||
| 1 | 211 EAST CHICAGO AVE STE 1720 | CHICAGO | IL | 60611 | $5,000 | Yes (X) |
| NATIONAL DENTAL BOARD OF ANESTHESIO | ||||||
| 2 | 211 EAST CHICAGO AVE STE 1720 | CHICAGO | IL | 60611 | $5,000 | Yes (X) |
| AMERICAN ASSOC OF NURSE ANESTHETIST | ||||||
| 3 | 222 SOUTH PROSPECT AVE | PARK RIDGE | IL | 60068 | $10,000 | Yes (X) |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $1,350 | Amt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|
| LICENSES AND FEES | $355 | |
| MARKETING AND WEB SITE EXPENSES | $6,592 | $3,296 |
| MERCHANT SERVICE CC FEES | $395 |
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 |
Comments