DENTAL PATIENT SAFETY FOUNDATION: Form 990PF, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: DENTAL PATIENT SAFETY FOUNDATION (EIN 82-2245000)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2018-11-02
IRS object ID: 201813069349100901
Schema version: 2017v2.3
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
General Explanation Attachment
Other Expenses Schedule
Substantial Contributors Sch

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-11-02T09:26:05-00:00	ReturnTs
Tax Period End	2018-06-30	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 St	AddressLine1Txt
City	Mt Prospect	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60056	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990PF	ReturnTypeCd
Tax Period Begin	2017-07-01	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	CHAIRMAN	PersonTitleTxt
Phone	8332167931	PhoneNum
Signature	2018-11-02	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	2018-11-02	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	173.15.56.28	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2018-11-02	IPDt
IP Tm	15:57:05	IPTm
IP Timezone	CD	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	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990-PF IRS990PF

Field	Value	IRS element (for citing)
Initial Return	Yes (X)	InitialReturnInd
Organization501c3 Exempt PF	Yes (X)	Organization501c3ExemptPFInd
FMV Assets EOY	$28,230	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	$34,200	ContriRcvdRevAndExpnssAmt
Cap Gain Net Incm Net Invst Incm	$0	CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss	$34,200	TotalRevAndExpnssAmt
Total Net Invst Incm	$0	TotalNetInvstIncmAmt
Printing And Pub Rev And Expnss	$600	PrintingAndPubRevAndExpnssAmt
Other Expenses Rev And Expnss	$5,370	OtherExpensesRevAndExpnssAmt
Other Expenses Dsbrs Chrtbl	$4,641	OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss	$5,970	TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm	$0	TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl	$4,641	TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss	$0	ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl	$0	ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss	$5,970	TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm	$0	TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl	$4,641	TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses	$28,230	ExcessRevenueOverExpensesAmt
Net Investment Income	$0	NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

Field	Value	IRS element (for citing)
Cash EOY	$28,230	CashEOYAmt
Cash EOYFMV	$28,230	CashEOYFMVAmt
Total Assets EOY	$28,230	TotalAssetsEOYAmt
Total Assets EOYFMV	$28,230	TotalAssetsEOYFMVAmt
Total Liabilities EOY	$0	TotalLiabilitiesEOYAmt
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind
Unrestricted EOY	$28,230	UnrestrictedEOYAmt
Tot Net Ast Or Fund Balances EOY	$28,230	TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY	$0	TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY	$28,230	TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

Field	Value	IRS element (for citing)
Excess Revenue Over Expenses	$28,230	ExcessRevenueOverExpensesAmt
Subtotal	$28,230	SubtotalAmt
Tot Net Ast Or Fund Balances EOY	$28,230	TotNetAstOrFundBalancesEOYAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

Field	Value	IRS element (for citing)
Investment Income Excise Tax	$0	InvestmentIncomeExciseTaxAmt

Statements Regarding Acty StatementsRegardingActyGrp

Field	Value	IRS element (for citing)
Legislative Political Acty	false	LegislativePoliticalActyInd
More Than100 Spent	false	MoreThan100SpentInd
Form1120 POL Filed	false	Form1120POLFiledInd
Activities Not Previously Rpt	false	ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws	false	ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit	false	UnrelatedBusIncmOverLimitInd
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
Undistr Incm Sect4942a2 Not App	false	UndistrIncmSect4942a2NotAppInd
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	N/A - INITIAL YEAR SOLICIT CONTRIBUTIONS, DESIGN AND DEVELOP WEBSITE FOR DATA COLLECTION	Description1Txt
Expenses1	$4,490	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	$19,605	AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast	$0	FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets	$19,605	TotalFMVOfUnusedAssetsAmt
Adjusted Total FMV Of Unused Ast	$19,605	AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable	$294	CashDeemedCharitableAmt
Net Vl Noncharitable Assets	$19,311	NetVlNoncharitableAssetsAmt
Minimum Investment Return	$966	MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

Field	Value	IRS element (for citing)
Minimum Investment Return	$966	MinimumInvestmentReturnAmt
Distributable Before Adj	$966	DistributableBeforeAdjAmt
Distributable Before Ded	$966	DistributableBeforeDedAmt
Distributable As Adjusted	$966	DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

Field	Value	IRS element (for citing)
Expenses And Contributions	$4,641	ExpensesAndContributionsAmt
Qualifying Distributions	$4,641	QualifyingDistributionsAmt
Adjusted Qualifying Distri	$4,641	AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

Field	Value	IRS element (for citing)
Distributable As Adjusted	$966	DistributableAsAdjustedAmt
Qualifying Distributions	$4,641	QualifyingDistributionsAmt
Applied To Current Year	$966	AppliedToCurrentYearAmt
Remaining Distri From Corpus	$3,675	RemainingDistriFromCorpusAmt
Total Corpus	$3,675	TotalCorpusAmt
Undistributed Income CY	$0	UndistributedIncomeCYAmt
Excess Distri Cyov To Next Yr	$3,675	ExcessDistriCyovToNextYrAmt
Excess From Current Year	$3,675	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	$4,641	CurrentYearAmt
Total	$4,641	TotalAmt

Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp

Field	Value	IRS element (for citing)
Current Year	$4,641	CurrentYearAmt
Total	$4,641	TotalAmt

Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp

Field	Value	IRS element (for citing)
Current Year	$644	CurrentYearAmt
Total	$644	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
ANESTHESIA RESEARCH FOUNDATION
1	211 EAST CHICAGO AVE STE 1729	CHICAGO	IL	60611	$10,000	Yes (X)
AMERICAN ASSOCIATION OF ORAL AND MA
2	9700 W BRYN MAWR AVE	ROSEMONT	IL	60018	$10,000	Yes (X)
FLORIDA DENTAL SOCIETY OF ANESTHESI
3	PO BOX 444	ORANGE PARK	FL	32067	$6,000	Yes (X)

General Explanation Attachment GeneralExplanationAttachment

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (5 entries)

DescDesc	Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt	Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt
INTERNET EXPENSES	$151	$151
LICENSES AND FEES	$10
WEB SITE DEVELOPMENT	$4,490	$4,490
MERCHANT SERVICE CC FEES	$569
OFFICE SUPPLIES	$150

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 2017

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

Preparer Person PreparerPersonGrp

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Form 990-PF IRS990PF

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

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

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

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 (3 entries)

General Explanation Attachment GeneralExplanationAttachment

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (5 entries)

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail (3 entries)

Comments