PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST (EIN 34-2012430)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-02-20
- IRS object ID
- 201540519349300344
- Schema version
- 2013v4.0
- 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 | 2015-02-20T13:26:23-08:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Goranson and Associates Inc | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 717 College Avenue First Floor | AddressLine1 |
| City | Santa Rosa | City |
| State | CA | State |
| ZIP Code | 95404 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 342012430 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pediatric Dental Initiative | BusinessNameLine1 |
| Business Name Line2 | of the North Coast Inc | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PEDI | BusinessNameControlTxt |
| Phone | 7078378833 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1380 19th Hole Drive | AddressLine1 |
| City | Windsor | City |
| State | CA | State |
| ZIP Code | 95492 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Viveka Rydell | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2015-02-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Susan E Goranson | PreparerPersonNm |
| PTIN | P00049464 | PTIN |
| Phone | 7075421256 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Viveka Rydell | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1380 19th Hole Drive | AddressLine1 |
| City | Windsor | City |
| State | CA | State |
| ZIP Code | 954927713 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,785,179 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pedidental.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | To maintain a sustainable dentistry resource that will serve the low income children of Northern California who need safe sedation for dental treatment, and to provide prevention education and promote oral health. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 28 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $236,354 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,155,880 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,241,821 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,542,006 | CYProgramServiceRevenueAmt |
| PY Investment Income | $165 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,108 | CYInvestmentIncomeAmt |
| PY Other Revenue | $201,781 | PYOtherRevenueAmt |
| CY Other Revenue | $74,827 | CYOtherRevenueAmt |
| PY Total Revenue | $2,680,121 | PYTotalRevenueAmt |
| CY Total Revenue | $3,774,821 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $981,600 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,036,643 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,051,020 | PYOtherExpensesAmt |
| CY Other Expenses | $2,179,730 | CYOtherExpensesAmt |
| PY Total Expenses | $3,032,620 | PYTotalExpensesAmt |
| CY Total Expenses | $3,216,373 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$352,499 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $558,448 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,842,321 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,884,722 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $700,825 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $209,778 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,141,496 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,674,944 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To maintain a sustainable dentistry resource that will serve the low income children of Northern California who need safe sedation for dental treatment, and to provide prevention education and promote oral health. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,978,136 | ExpenseAmt |
| Revenue | $2,542,006 | RevenueAmt |
| Desc | PDI Surgery Center provides an oral surgery resource for children from low-income families, and children and adults with developmental disabilities, throughout Northern California. Since opening in January 2008, over 2,074 children have received treatment and over 188 families have received travel assistance.The case management component of PDI Surgery Center is intended to improve long-term oral health outcomes in young children, and in children and adults with developmental disabilities who live in Northern California. Case managers provide extensive support to health care providers and families seeking care at the surgery center. PDI works collaboratively with case managers from referral agencies to assist with filling out referral forms, protocols and procedures into existing case management systems. Our case managers travel throughout Sonoma, Mendocino, Lake, Napa and Marin counties to increase efficiencies in the referral and follow up process.PDI case managers act as problem solvers for families, referring agencies, the community and the surgery center. Their primary responsibility is to provide necessary services to families, assisting them with gaining access to dental services under general anesthesia. These responsibilities include: providing interpretive services, arranging transportation for clients to and from the clinic, lodging if necessary and ensuring that all forms are filled out in a timely manner. Case managers ensure that patients are enrolled in the health insurance program for which they are eligible, and will facilitate that enrollment prior to treatment. If a family is not eligible for an insurance program, and cannot afford care, the case manager will assist the family in applying for enrollment in a Patient Sponsorship Program. As part of its long-term strategy to reduce the need for intervention surgery services, PDI case managers combine prevention education and community outreach efforts to best educate families.PDIs unique Patient Sponsorship Program (PSP) helps families bridge access barriers that include expensive transportation, lodging and medication costs. Other considerations include subsidizing treatment expenses, based on a sliding scale, for families who do not qualify for MediCal, Healthy Families, or other insurance programs. | Desc |
| Total Program Service Expenses | $2,978,136 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 28 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Viveka Rydell | PersonNm |
| Phone | 7078378833 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1380 19th Hole Drive | AddressLine1 |
| City | Windsor | City |
| State | CA | State |
| ZIP Code | 954927713 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Ross E Stromberg | |||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Max Dunn | |||||||
| Secretary/Treas | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Katherine Foster | |||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Bill Hawn | |||||||
| Chairman | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Connie Codding | |||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Tom Jordan | |||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Anne Molgaard | |||||||
| Vice-chair | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Suzie Shupe | |||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Thomas Cleland | |||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Julie Tucker | |||||||
| nurse director | 40.00 | 0.00 | $116,445 | $0 | $0 | Yes (X) | |
| Viveka Rydell | |||||||
| CEO | 40.00 | 0.00 | $92,177 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $208,622 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Kristin Johnson MD | |||||
| Post Office Box 863 | Geyserville | CA | 95441 | Medical Director | $153,300 |
| Mark Hagele DDS | |||||
| 101 Providence Mine Road | Nevada City | CA | 95959 | Dental Director | $157,500 |
| Michael Mundell MD | |||||
| 1400 Quail Court | Santa Rosa | CA | 95404 | Anesthesiologist | $150,000 |
| Tanvi Shah DDS | |||||
| 1071 Via Alta | Lafayette | CA | 94549 | Dentist | $130,750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $150,000 | FundraisingAmt |
| Government Grants | $601,166 | GovernmentGrantsAmt |
| All Other Contributions | $404,714 | AllOtherContributionsAmt |
| Total Contributions | $1,155,880 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| Other revenue | $329 | $329 |
| Program fees | $2,541,677 | $2,541,677 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,542,006 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,108 | TotalRevenueColumnAmt |
| Exclusion | $2,108 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $85,185 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $150,000 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $10,358 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,827 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,774,821 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,542,006 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $2,108 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,622 | TotalAmt |
| Program Services | $116,445 | ProgramServicesAmt |
| Management And General | $92,177 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $828,021 | TotalAmt |
| Program Services | $754,292 | ProgramServicesAmt |
| Management And General | $73,729 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,314,318 | TotalAmt |
| Program Services | $1,305,927 | ProgramServicesAmt |
| Management And General | $8,391 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,007 | TotalAmt |
| Program Services | $25,481 | ProgramServicesAmt |
| Management And General | $3,526 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,624 | TotalAmt |
| Program Services | $197,610 | ProgramServicesAmt |
| Management And General | $23,014 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,492 | TotalAmt |
| Program Services | $111,299 | ProgramServicesAmt |
| Management And General | $193 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,563 | TotalAmt |
| Program Services | $15,569 | ProgramServicesAmt |
| Management And General | $3,994 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| supplies and equipment | $399,802 | $399,716 | $86 |
| Other operating expenses | $46,143 | $28,516 | $17,627 |
| Program expense | $26,107 | $15,771 | $10,336 |
| communications | $8,304 | $4,731 | $3,573 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,370 | TotalAmt |
| Program Services | $2,779 | ProgramServicesAmt |
| Management And General | $1,591 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,216,373 | TotalAmt |
| Program Services | $2,978,136 | ProgramServicesAmt |
| Management And General | $238,237 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $387,083 | BOYAmt |
| EOY | $483,697 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,262 | BOYAmt |
| EOY | $174,665 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $384,970 | BOYAmt |
| EOY | $350,274 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,364 | BOYAmt |
| EOY | $78,209 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,055 | BOYAmt |
| EOY | $26,102 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,120,063 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $673,738 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $550,162 | BOYAmt |
| EOY | $446,325 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,000 | BOYAmt |
| EOY | $175,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,425 | BOYAmt |
| EOY | $150,450 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,842,321 | BOYAmt |
| EOY | $1,884,722 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $682,824 | BOYAmt |
| EOY | $206,778 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,000 | BOYAmt |
| EOY | $3,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $700,825 | BOYAmt |
| EOY | $209,778 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $999,033 | BOYAmt |
| EOY | $1,487,369 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,463 | BOYAmt |
| EOY | $187,575 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,141,496 | BOYAmt |
| EOY | $1,674,944 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,842,321 | BOYAmt |
| EOY | $1,884,722 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $558,448 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$25,000 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | $136,370 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $449,234 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $541,296 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $236,354 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,155,880 | CurrentTaxYearAmt |
| Total | $2,519,134 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $136,370 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $449,234 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $541,296 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $236,354 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,155,880 | CurrentTaxYearAmt |
| Total | $2,519,134 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $0 | SubstantialContributorsTotAmt |
| Public Support Total170 | $2,519,134 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,262 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $52 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $64 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $165 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,108 | CurrentTaxYearAmt |
| Total | $3,651 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $2,522,785 | TotalSupportAmt |
| Public Support CY170 | 0.99860 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99820 | 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) |
|---|---|---|
| Other Cost Or Other Basis | $855,170 | OtherCostOrOtherBasisAmt |
| Depreciation | $570,113 | DepreciationAmt |
| Book Value | $285,057 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,113 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,113 | DepreciationAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $254,780 | OtherCostOrOtherBasisAmt |
| Depreciation | $93,512 | DepreciationAmt |
| Book Value | $161,268 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $446,325 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | other receivables | Desc |
| Book Value | $150,450 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $150,450 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $3,774,821 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $3,774,821 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $3,774,821 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,241,373 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $25,000 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $25,000 | ExpensesNotReportedAmt |
| Expenses Subtotal | $3,216,373 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $3,216,373 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X : FIN48 Footnote | Pediatric Dental Initiative is exempt from income taxation under Section 501(c)(3) of the Internal Revenue Code. The Internal Revenue Service has determined PDI is not a private foundation under Section 509(a)(2). Generally accepted accounting principles provide accounting and disclosure guidance about positions taken by an Organization in its tax returns that might be uncertain. Management has considered its tax positions and believes that all of the positions taken by the Organization in their federal and state exempt Agency tax returns are more likely than not to be sustained upon examination. PDI's evaluation on June 30, 2012 revealed no tax positions that would have a material impact on the financial statements. PDI does not believe that any reasonably possible changes will occur within the next twelve months that will have a material impact on the financial statements. |
| Part XII, Line 2d: Other expenses and losses per audited F/S | IMPAIRMENT OF GOODWILL $25000 |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | false | AgrmtProfFundraisingActyInd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Make Kids Smile Luncheon/Gold Event | NameOfEvent1Amt |
| Gross Receipts Event1 | $235,185 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $150,000 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $85,185 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $10,358 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $235,185 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $150,000 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $85,185 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $10,358 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $10,358 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $74,827 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | Revolving line of credit is guaranteed by a community member |
| Form 990, Part VI, Line 11b: Form 990 Review Process | 990 is emailed to board and reviewed by finance committee before submission |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Agenda item |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | Reviewed and set by board annually |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Documents available upon request |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | IMPAIRMENT OF GOODWILL = -$25000 |