PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- PEDIATRIC DENTAL INITIATIVE OF THE NORTH COAST (EIN 34-2012430)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-04-26
- IRS object ID
- 201331169349300208
- Schema version
- 2011v1.5
- 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) |
|---|---|---|
| Timestamp | 2013-04-26T08:07:47-07:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Goranson and Associates Inc | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 446 Beaver Street | AddressLine1 |
| City | Santa Rosa | City |
| State | CA | State |
| ZIP Code | 95404 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 342012430 | EIN |
Name Name
| 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) |
|---|---|---|
| Name Control | PEDI | NameControl |
| Phone | 7078378833 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Viveka Rydell | Name |
| Title | CEO | Title |
| Date Signed | 2013-04-25 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Susan E Goranson | Name |
| Phone | 7075421256 | Phone |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Viveka Rydell | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1380 19th Hole Drive | AddressLine1 |
| City | Windsor | City |
| State | CA | State |
| ZIP Code | 95492 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2819261 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.pedidental.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2005 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 25 | TotalNbrEmployees |
| Total Nbr Volunteers | 30 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 449243 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 621296 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2208946 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2087882 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 52 | InvestmentIncomePriorYear |
| Investment Income Current Year | 64 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 156309 | OtherRevenuePriorYear |
| Other Revenue Current Year | 92146 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2814550 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2801388 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 882479 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 922168 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1918287 | OtherExpensePriorYear |
| Other Expenses Current Year | 1870949 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2800766 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2793117 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 13784 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 8271 | RevenuesLessExpensesCY |
| Total Assets BOY | 1698228 | TotalAssetsBOY |
| Total Assets EOY | 1670148 | TotalAssetsEOY |
| Total Liabilities BOY | 187504 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 176153 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1510724 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1493995 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 2561921 | Expense |
| Revenue | 2087799 | Revenue |
| Description | 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 8,550 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. | Description |
| Total Program Service Expense | 2561921 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | false | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 9 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 25 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Viveka Rydell | NamePerson |
| Telephone Number | 7078378833 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1380 19th Hole Drive | AddressLine1 |
| City | Windsor | City |
| State | CA | State |
| ZIP Code | 95492 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| Veronika Sumbera | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| Thomas Cleland | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| Suzie Shupe | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| Anne Molgaard | ||||||
| Vice-chair | 2.00 | X | 0 | 0 | 0 | |
| Tom Jordan | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| Connie Codding | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| Bill Hawn | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| Katherine Foster | ||||||
| Chairman | 2.00 | X | 0 | 0 | 0 | |
| Max Dunn | ||||||
| Secretary/Treas | 2.00 | X | 0 | 0 | 0 | |
| Ross E Stromberg | ||||||
| Director | 2.00 | X | 0 | 0 | 0 | |
| Viveka Rydell | ||||||
| CEO | 40.00 | 92308 | 0 | 0 | X | |
| Julie Tucker | ||||||
| nurse director | 40.00 | 110250 | 0 | 0 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 202558 | TotalReportableCompFromOrg |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Tanvi Shah DDS | |||||
| 1071 Via Alta | Lafayette | CA | 94549 | Dentist | 190750 |
| Michael Mundell MD | |||||
| 1400 Quail Court | Santa Rosa | CA | 95404 | Anesthesiologist | 197400 |
| Mark Hagele DDS | |||||
| 101 Providence Mine Road | Nevada City | CA | 95959 | Dental Director | 223050 |
| Kristin Johnson MD | |||||
| Post Office Box 863 | Geyserville | CA | 95441 | Anesthesiologist | 212550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Fundraising Events | 80000 | FundraisingEvents |
| Government Grants | 5000 | GovernmentGrants |
| All Other Contributions | 536296 | AllOtherContributions |
| Total Contributions | 621296 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| Program fees | 2087799 | 2087799 |
| Other revenue | 83 | 83 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2087882 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64 | TotalRevenueColumn |
| Exclusion | $64 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 110019 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 80000 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 17873 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 92146 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2801388 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2087882 | RelatedOrExemptFunctionIncome |
| Exclusion | $64 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 202558 | Total |
| Program Services | 202558 | ProgramServices |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 587453 | Total |
| Program Services | 422030 | ProgramServices |
| Management And General | 165423 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65635 | Total |
| Program Services | 65635 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66522 | Total |
| Program Services | 66522 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1193964 | Total |
| Program Services | 1189289 | ProgramServices |
| Management And General | 4675 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42246 | Total |
| Program Services | 32272 | ProgramServices |
| Management And General | 9974 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 215564 | Total |
| Program Services | 192550 | ProgramServices |
| Management And General | 23014 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100089 | Total |
| Program Services | 97990 | ProgramServices |
| Management And General | 2099 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28303 | Total |
| Program Services | 24957 | ProgramServices |
| Management And General | 3346 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| communications | 11647 | 6292 | 5355 |
| Program expense | 18960 | 8828 | 10132 |
| Other operating expenses | 27291 | 21255 | 6036 |
| supplies and equipment | 225275 | 225275 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7610 | Total |
| Program Services | 6468 | ProgramServices |
| Management And General | 1142 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2793117 | Total |
| Program Services | 2561921 | ProgramServices |
| Management And General | 231196 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 328960 | BOY |
| EOY | 506084 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30410 | BOY |
| EOY | 55111 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 70000 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 304902 | BOY |
| EOY | 100361 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 88928 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29768 | BOY |
| EOY | 21779 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1037026 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 453709 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 684188 | BOY |
| EOY | 583317 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 250000 | BOY |
| EOY | 225000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 89568 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1698228 | BOY |
| EOY | 1670148 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 187504 | BOY |
| EOY | 176153 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 187504 | BOY |
| EOY | 176153 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1451160 | BOY |
| EOY | 1402745 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59564 | BOY |
| EOY | 91250 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1510724 | BOY |
| EOY | 1493995 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1698228 | BOY |
| EOY | 1670148 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 8271 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -25000 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 639678 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 544695 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 136370 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 449234 | CurrentTaxYearMinus1Year |
| Current Tax Year | 541296 | CurrentTaxYear |
| Total | 2311273 | Total |
Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 639678 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 544695 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 136370 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 449234 | CurrentTaxYearMinus1Year |
| Current Tax Year | 541296 | CurrentTaxYear |
| Total | 2311273 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 0 | AmountsSubstContributorsTotal |
| Public Support Total170 | 2311273 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 12410 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1920 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1262 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 52 | CurrentTaxYearMinus1Year |
| Current Tax Year | 64 | CurrentTaxYear |
| Total | 15708 | Total |
Net UBI NetUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 2326981 | TotalSupport |
| Public Support Pertcentage170 | 0.99320 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.98480 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 855170 | OtherCostOrOtherBasis |
| Depreciation | 399079 | Depreciation |
| Book Value | 456091 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 181856 | OtherCostOrOtherBasis |
| Depreciation | 54630 | Depreciation |
| Book Value | 127226 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 583317 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | other receivables | Description |
| Book Value | 89568 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 89568 | TotalBookValueOtherAssets |
| Total Revenue | 2801388 | TotalRevenue |
| Total Expenses | 2793117 | TotalExpenses |
| Excess Or Deficit For Year | 8271 | ExcessOrDeficitForYear |
| Other | -$25,000 | OtherAmount |
| Total Adjustments | -25000 | TotalAdjustments |
| Excess Or Deficit Per FS | -16729 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 2801388 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 2801388 | RevenueSubtotal |
| Total Revenue Per Form990 | 2801388 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2818117 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 25000 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 25000 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2793117 | ExpensesSubtotal |
| Total Expenses Per Form990 | 2793117 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X | 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 XIII, Line 2d | Part XIII, 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 | X | MailSolicitations |
| Email Solicitations | X | EmailSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Solicitation Of Govt Grants | X | SolicitationOfGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | false | AgreementRefFundraising |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Make Kids Smile Luncheon | NameOfEvent1 |
| Gross Receipts Event1 | 190019 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 80000 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 110019 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 17873 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 190019 | GrossReceiptsTotal |
| Charitable Contributions Total | 80000 | CharitableContributionsTotal |
| Gross Revenue Total Events | 110019 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 17873 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 17873 | DirectExpenseSummaryEvents |
| Net Income Summary | 92146 | NetIncomeSummary |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Documents available upon request |
| Form 990, Part VI, Line 15b | 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 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Agenda item |
| Form 990, Part VI, Line 11 | Form 990, Part VI, Line 11: Form 990 Review Process | 990 is emailed to board and reviewed by finance committee before submission |
| Form 990, Part VI, Line 2 | Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | Revolving line of credit is guaranteed by a board member |