2023-11-01T08:51:41-05:00 2022-12-31 411360831 OLSEN THIELEN & CO LTD 2675 LONG LAKE ROAD ST PAUL MN 55113 990 2022-01-01 411927049 MINNESOTA DENTAL FOUNDATION MINN 6127678400 1335 INDUSTRIAL BLVD 200 MINNEAPOLIS MN 554134801 CARMELO CINQUEONCE EXECUTIVE DIRECTOR 6127678400 2023-09-18 1 CARMELO CINQUEONCE 999009999 1 RYAN VETTRUS CPA P01243596 6514834521 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DR STEPHEN F LITTON 1335 INDUSTRIAL BLVD 200 MINNEAPOLIS MN 554134801 900910 0 X WWW.MNDENTALFOUNDATION.ORG X 1997 MN THE VISION OF THE MINNESOTA DENTAL FOUNDATION IS TO ELIMINATE UNMET ORAL HEALTH NEEDS IN MN. 13 13 0 1200 0 0 743570 577260 0 0 19215 31293 0 -31585 762785 576968 184197 236419 0 0 0 0 0 0 2472 54384 318256 238581 554675 524204 22293 2080095 2153028 1201 0 2078894 2153028 X MINNESOTA DENTAL FOUNDATION'S MISSION IS TO INITIATE AND SUPPORT PROGRAMS THAT PROVIDE DENTAL SERVICES TO UNDERSERVED POPULATIONS AND COMMUNITIES; ENCOURAGE AND SUPPORT VOLUNTEERISM WITHIN THE PROFESSION; AND PROMOTE CAREERS IN DENTISTRY, ESPECIALLY IN UNDERSERVED AREAS. 0 0 155007 155007 GRANTS WERE GIVEN TO BOARD-APPROVED ORGANIZATIONS THAT HAVE AN INTEREST IN IMPROVING THE ORAL HEALTHCARE OF THE UNDERSERVED IN MINNESOTA. THESE GRANTS INCLUDED COMMUNITY AND VOLUNTEER DENTAL CLINICS THROUGHOUT THE STATE, NON-DENTAL NOT FOR PROFIT ORGANIZATIONS THAT HAVE AN INTEREST IN ORAL HEALTHCARE, AS WELL AS THOSE NOT FOR PROFIT CLINICS INVOLVED IN THE NATIONALLY RECOGNIZED GIVE KIDS A SMILE PROGRAM IN FEBRUARY. 274261 TWO SIGNIFICANT PROGRAMS HELP THE UNDERSERVED ACCESS FREE DENTAL CARE. THE MINNESOTA MISSION OF MERCY PROJECT PROVIDES FREE DENTAL CARE TO PATIENTS OVER A WEEKEND VISITING A DIFFERENT CITY IN MINNESOTA EACH YEAR. THE DONATED DENTAL SERVICES PROVIDE ELDERLY, DISABLED OR MEDICALLY FRAGILE INDIVIDUALS WHO COULD NOT AFFORD NEEDED DENTISTRY WITH FREE DENTAL CARE IN PRIVATE DENTAL OFFICES THROUGHOUT THE YEAR. A SECOND PROGRAM IS THE MINNESOTA HEROES ORTHODONTIC PROGRAM WHICH PROVIDES FREE ORTHODONTIC CARE TO CHILDREN AND SPOUSES OF GOLD STAR FAMILIES. 78800 78800 EDUCATION LOAN FORGIVENESS MONIES WERE GIVEN TO THREE DENTISTS WHO HAVE AGREED TO PRACTICE IN THE TACONITE ASSISTANCE AREA OF NORTHEASTERN MINNESOTA FOR AT LEAST FIVE YEARS TO HELP WITH ACCESS TO DENTAL SERVICES IN THAT PART OF THE STATE. THE FOUNDATION ALSO ADVISED THE DELTA DENTAL OF MINNESOTA FOUNDATION IN CREATING A PROGRAM TO HELP REPAY EDUCATIONAL LOANS FOR RECIPIENTS PRACTICING IN A RURAL HEALTH PROFESSIONS SHORTAGE AREA (HPSA) FOR FIVE YEARS. 2612 2612 THE MINNESOTA DENTAL FOUNDATION OVERSEES A PROGRAM THAT HELPS RETIRED DENTISTS MAINTAIN THEIR DENTAL LICENSE AS LONG AS THEY ARE NOT RECEIVING ANY INCOME FROM DENTISTRY AND AGREE TO ONLY PROVIDE DENTISTRY TO THE UNDERSERVED. 2612 2612 510680 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X THE ORGANIZATION 6127678400 1335 INDUSTRIAL BLVD STE 200 MINNEAPOLIS MN 554134801 CARMELO CINQUEONCE EXECUTIVE DIRECTOR, MN DENTAL ASSN 1.00 50.00 X 0 275366 12185 VICKI CAPISTRANT DIRECTOR OF OPERATIONS 1.00 40.00 X 0 108569 8064 DR STEPHEN LITTON PRESIDENT 25.00 X X 0 0 0 DR MICHAEL KURKOWSKI TREASURER 1.00 X X 0 0 0 DR LAURA ENG SECRETARY 1.00 X X 0 0 0 DR AMBER CZIOK DIRECTOR 1.00 X 0 0 0 S RENEE DOTSON JD DIRECTOR 1.00 X 0 0 0 BRUCE DOWNEY DIRECTOR 1.00 X 0 0 0 DR ANGELA HASTINGS DIRECTOR 1.00 X 0 0 0 DR LEE JESS DIRECTOR 1.00 X 0 0 0 DR KIRSTEN LANGGUTH DIRECTOR 1.00 X 0 0 0 DR ROSALIE PERPICH DIRECTOR 1.00 X 0 0 0 DR KARL SELF DIRECTOR 1.00 X 0 0 0 ERIK SKOE DIRECTOR 1.00 X 0 0 0 DR MICHAEL ZAKULA DIRECTOR 1.00 X 0 0 0 0 383935 20249 0 0 1 0 0 103585 120000 353675 82291 577260 31293 31293 262065 262065 0 0 30292 103585 61877 -31585 -31585 576968 0 0 -292 157619 157619 78800 78800 1190 1190 8500 8500 20000 20000 9174 7227 1947 4032 4032 469 469 MISSION OF MERCY PROGRA 274261 274261 MISCELLANEOUS 630 105 525 554675 510680 41523 2472 1430525 427936 8006 0 27684 0 611380 1722592 2500 2500 2080095 2153028 1201 0 1201 0 X 1103766 1161281 975128 991747 2078894 2153028 2080095 2153028 22293 -38159 90000 0 X 0 1 X 0 0 X 912442 237335 166244 743570 577260 2636851 912442 237335 166244 743570 577260 2636851 7500 16791 24291 0 7500 16791 24291 2612560 25695 31061 31656 19215 31293 138920 25695 31061 31656 19215 31293 138920 131143 114152 30292 275587 1069280 382548 197900 762785 638845 3051358 0.85620 0.81560 0.04550 0.04670 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: FUNDRAISING INCOME - 2018 AMOUNT: $ 131,143. 2019 AMOUNT: $ 114,152. 2020 AMOUNT: $ 0. 2021 AMOUNT: $ 0. 2022 AMOUNT: $ 30,292. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X 690686 -38159 90000 61877 113718 576968 0 576968 616552 61877 61877 554675 0 554675 PART X, LINE 2: ASC 740 DISCLOSURE: THE FOUNDATION OPERATES ON A NONPROFIT BASIS AND HAS BEEN GRANTED TAX EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; THEREFORE, THE STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES. THE FOUNDATION REVIEWS INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN INCOME TAX RETURNS TO DETERMINE IF THERE ARE ANY INCOME TAX UNCERTAINTIES. THIS INCLUDES POSITIONS THAT THE ENTITY IS EXEMPT FROM INCOME TAXES OR NOT SUBJECT TO INCOME TAXES ON UNRELATED BUSINESS INCOME. THE FOUNDATION RECOGNIZES TAX BENEFITS FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITIONS. THE FOUNDATION HAS IDENTIFIED NO SIGNIFICANT INCOME TAX UNCERTAINTIES. THE FOUNDATION FILES INFORMATION RETURNS AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 61,877. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 61,877. ONESMILE GALA 133877 103585 30292 4500 38657 18720 133877 103585 30292 4500 38657 18720 61877 -31585 1 DENTAL LIFELINE NETWORK 1800 15TH ST STE 100 DENVER CO 80202 846129064 501(C)(3) 86363 0 SUPPORT MN DONATED DENTAL SERVICES PROGRAM GIVE KIDS A SMILE CO MN DENTAL ASSOCIATION 1335 INDUSTRIAL BLVD 200 MINNEAPOLIS MN 55413 410418600 501(C)(6) 11300 0 GIVE KIDS A SMILE-FREE DENTAL CARE PROGRAM FOR CHILDREN IN NEED HOPE DENTAL CLINIC 800 MINNEHAHA AVE E STE 465 ST PAUL MN 55106 814068287 501(C)(3) 8000 0 TO PURCHASE DENTAL EQUIPMENT AND FUND THE ST. PAUL DENTAL CONNECT PROJECT. 2 1 MARTHA MORDINI RUKAVINA LOAN FORGIVENESS PROGRAM - EDUCATION LOAN FORGIVENESS TO DENTISTS SERVING IN TAA AREA. 3 78800 PART I, LINE 2: GRANT RECIPIENTS ARE ASKED TO PROVIDE BRIEF FEEDBACK OF THEIR PROGRAMS, SUCH AS NUMBER OF CHILDREN PARTICIPATING; TYPES OF PROCEDURES/SERVICES PROVIDED; RECEPTION OF PROGRAM BY PATIENTS AND THEIR PARENTS/GUARDIANS, ETC. THE FOUNDATION FOLLOWS UP WITH GRANT RECIPIENTS THAT HAVE NOT SUBMITTED A RESPONSE. 0 0 0 0 0 0 0 0 0 CARMELO CINQUEONCE EXECUTIVE DIRECTOR, MN DENTAL ASSN 0 275366 0 0 0 0 0 10108 0 2077 0 287551 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS PAID BY THE FOUNDATION'S PARENT COMPANY: MINNESOTA DENTAL ASSOCIATION. THE COMPENSATION IS ESTABLISHED THROUGH AN INDEPENDENT COMPENSATION CONSULTANT, IS APPROVED BY THE BOARD OF TRUSTEES, AND INCLUDED IN A WRITTEN EMPLOYMENT CONTRACT. X 2 27106 FMV X 6 55185 ACTUAL VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED. THE CHANGES INCLUDE GREATER CLARITY IN GRANT GIVING, EXPANSION OF ELECTRONIC COMMUNICATIONS, CREATION OF A STANDING NOMINATING & GOVERNANCE COMMITTEE, ADDITION OF A VICE PRESIDENT OFFICE, OFFICER TERM LIMITS, CREATION OF IMMEDIATE PAST PRESIDENT POSITION, REVISION OF INDEMNIFICATION ARTICLE, ADDITION OF A GOVERNING PARLIAMENTARY AUTHORITY, AND ADOPTION OF ADA CODE OF PROFESSIONAL CONDUCT. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE MN DENTAL FOUNDATION IS THE MN DENTAL ASSOCIATION, ACTING THROUGH ITS BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A MINNESOTA DENTAL ASSOCIATION BOARD OF TRUSTEES ELECTS MEMBERS OF THE FOUNDATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B CHANGES TO ARTICLES OR BYLAWS MUST BE APPROVED BY THE MEMBER (MDA) FORM 990, PART VI, SECTION B, LINE 11B THE FOUNDATION'S FORM 990 IS REVIEWED BY THE FOUNDATION'S PRESIDENT, EXECUTIVE DIRECTOR AND TREASURER. COPIES OF THE APPROVED RETURN ARE DISTRIBUTED ELECTRONICALLY TO MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO FILING THE FORM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS SIGN AN ANNUAL CONFLICT OF INTEREST POLICY STATEMENT AND ARE REQUIRED TO NOTIFY A BOARD OFFICER IF CONFLICTS ARISE THROUGHOUT THE YEAR. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION HAS NO EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY A WRITTEN REQUEST TO THE MINNESOTA DENTAL FOUNDATION. MINNESOTA DENTAL ASSOCIATION 1335 INDUSTRIAL BLVD STE 200 MINNEAPOLIS MN 554134801 410418600 PROFESSIONAL ASSN OF DENTISTS MN 501(C)(6) N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0