2024-02-21T13:06:27-06:00 2023-12-20 871353108 EISNER ADVISORY GROUP LLC 4225 EXECUTIVE SQUARE SUITE 1150 LA JOLLA CA 92037 990 2023-01-01 473001738 GARY AND MARY WEST SENIOR DENTAL CENTER INC GARY 6197951301 1525 4TH AVENUE SAN DIEGO CA 92101 SHELLEY LYFORD CHAIR & CEO 6197951301 2024-02-16 1 SHELLEY LYFORD 999009999 0 BRANDON SMITH P01389959 8585589200 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z X SHELLEY LYFORD 1525 4TH AVENUE SAN DIEGO CA 92101 976189 0 X WWW.SENIORDENTALCENTER.ORG X 2015 CA TO PROVIDE AFFORDABLE, HIGH-QUALITY ORAL HEALTHCARE WITH COMPREHENSIVE EDUCATION, CLINICAL, AND WELLNESS SERVICES FOR SENIORS IN NEED, ENABLING THEM TO LIVE HEALTHY, INDEPENDENT, AND PRODUCTIVE LIVES. X 3 3 11 3 0 0 1806327 680222 702742 295967 0 -490968 0 0 2509069 485221 0 1833542 0 0 1105569 539443 0 0 29349 865480 864397 1971049 3237382 538020 -2752161 2860259 0 153879 0 2706380 0 TO PROVIDE AFFORDABLE, HIGH-QUALITY ORAL HEALTHCARE WITH COMPREHENSIVE EDUCATION, CLINICAL, AND WELLNESS SERVICES FOR SENIORS IN NEED, ENABLING THEM TO LIVE HEALTHY, INDEPENDENT, AND PRODUCTIVE LIVES. 0 0 3040356 1833542 -195001 IN 2023, 597 UNDUPLICATED SENIORS RECEIVED SERVICES AT THE SENIOR DENTAL CENTER, WHICH INCLUDED 1,797 IN-PERSON VISITS. THE SENIOR DENTAL CENTER MAINTAINED A LOW 1.5 % NO-SHOW RATE DEMONSTRATING THE NEED FOR AGE-SPECIFIC, COMMUNITY-BASED DENTAL CARE. EFFORTS THIS YEAR FOCUSED ON SEEKING A SUSTAINABLE MODEL AND EXPLORING PARTNERSHIPS TO MEET THE ONGOING ORAL HEALTH NEEDS OF UNDERSERVED SENIORS. 3040356 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 12 0 1 11 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X NIKI POTTER 6197951301 1525 4TH AVENUE SAN DIEGO CA 92101 MARC HARPER DIRECTOR/VP/TREASURER/SECRETARY 5.00 X X 0 0 0 SHELLEY LYFORD DIRECTOR/SECRETARY/CEO/CHAIR 5.00 X X 0 0 0 DON CASEY DIRECTOR 5.00 X 0 0 0 KAREN BECERRA-PENAGOS CEO/DENTAL DIRECTOR (THROUGH 04/2023) 40.00 X 108274 0 2596 VICKI PETROPOULOS DENTIST 35.00 X 122863 0 4286 231137 0 6882 2 0 0 0 0 680222 118598 680222 DENTAL SERVICES 621300 295967 295967 295967 490968 -490968 -490968 -490968 485221 -195001 0 0 1833542 1833542 231137 193241 32482 5414 230383 212417 7047 10919 9536 8382 817 337 38163 33544 3269 1350 30224 26565 2589 1070 102531 102531 77269 77269 97364 97364 68850 68850 5119 5119 8752 7925 585 242 69462 66043 3419 52856 45226 5966 1664 3450 3450 76837 67537 6581 2719 24000 17888 5967 145 DENTAL SUPPLIES 163164 163164 PAYROLL PROCESSING FEES 62940 55322 5391 2227 LAB FEES 36214 36214 15589 16127 -381 -157 3237382 3040356 167677 29349 1817573 0 0 0 75076 0 0 0 0 0 32412 0 0 0 837116 0 0 0 0 0 98082 0 2860259 0 47994 0 105885 0 153879 0 X 2706380 0 0 2706380 0 2860259 0 X -2752161 45781 X 0 0 0 X FORM 990, PART IV, LINE 20A: ALTHOUGH THE ORGANIZATION HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE TO BE DESCRIBED IN INTERNAL REVENUE CODE SECTION 170(B)(1)(A)(III) BECAUSE IT PROVIDES OUTPATIENT SERVICES, IT IS NOT REQUIRED BY ITS STATE OF OPERATION TO BE LICENSED AS A HOSPITAL. THEREFORE, IT IS NOT REQUIRED TO PROVIDE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 SAN YSIDRO HEALTH 1601 PRECISION PARK LANE SAN DIEGO CA 92173 952801772 501(C)(3) 275000 331016 APPRAISAL COMPUTER EQUIPMENT, MEDICAL EQUIPMENT, AND SOFTWARE RETURN OF UNUSED GRANT FUNDS, DISSOLUTION TRANSFER GARY AND MARY WEST CHARITABLE TRUST 10350 N TORREY PINES ROAD LA JOLLA CA 92037 873374164 501(C)(3) 1227525 0 DISSOLUTION TRANSFER 1 X 1505 118598 COMPARABLE SALES 0 0 0 0 PART I, COLUMN (B): FOR THE PURPOSES OF THIS FORM, THE NUMBER OF CONTRIBUTIONS OF MEDICAL SUPPLIES IS DETERMINED BY THE NUMBER OF SEPARATE GIFTS RECEIVED IN ACCORDANCE WITH IRS REGULATIONS. COMPUTER EQUIPMENT, MEDICAL EQUIPMENT AND SOFTWARE 2023-10-19 331016 APPRAISAL 952801772 SAN YSIDRO HEALTH 1601 PRECISION PARK LANE SAN DIEGO CA 92173 501(C)(3) CASH 2023-12-04 275000 CASH 952801772 SAN YSIDRO HEALTH 1601 PRECISION PARK LANE SAN DIEGO CA 92173 501(C)(3) OFFICE AND COMPUTER EQUIPMENT 2023-12-20 0 NET BOOK VALUE 820635784 GARY AND MARY WEST SENIOR SERVICES INC 1706 DESCANSO AVENUE SAN MARCOS CA 92078 501(C)(3) CASH 2023-12-13 1227525 CASH 873374164 GARY AND MARY WEST CHARITABLE TRUST 10350 N TORREY PINES ROAD LA JOLLA CA 92037 501(C)(3) 0 0 0 0 1 1 1 1 0 FORM 990, PART VI, SECTION A, LINE 1A THE FORM 990 INFORMATION WAS COMPILED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. THE COMPLETED FORM 990 WAS REVIEWED BY THE ORGANIZATION'S CHAIR AND CEO. UPON SATISFACTORY COMPLETION OF THE REVIEW PROCESS, A DRAFT OF THE FORM 990 WAS CIRCULATED TO THE ORGANIZATION'S MANAGEMENT FOR REVIEW. THE FORM 990 WAS THEN FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION A, LINE 2 THERE ARE TWO INDIVIDUALS ON THE BOARD OF DIRECTORS FOR THE ORGANIZATION THAT ARE ALSO ON THE BOARD OF DIRECTORS FOR THE GARY AND MARY WEST CHARITABLE TRUST, WHICH IS THE MAJORITY CONTRIBUTOR TO THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS THAT HAVE GOVERNING POWERS. CERTAIN DECISIONS BY THE ORGANIZATION AND ITS BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF THESE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS MEMBERS THAT HAVE GOVERNING POWERS. CERTAIN DECISIONS BY THE ORGANIZATION AND ITS BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF THESE MEMEBERS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION HAS MEMBERS THAT HAVE GOVERNING POWERS. CERTAIN DECISIONS BY THE ORGANIZATION AND ITS BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF THESE MEMEBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 INFORMATION WAS COMPILED FROM THE ORGANIZATION'S CORPORATE AND ACCOUNTING RECORDS AND PROVIDED TO THE ORGANIZATION'S OUTSIDE TAX PREPARER. UPON SATISFACTORY COMPLETION OF THE INTERNAL REVIEW PROCESS, A DRAFT OF THE FORM 990 WAS CIRCULATED TO THE ORGANIZATION'S MANAGEMENT FOR REVIEW. THE FORM 990 WAS THEN FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH PRINCIPAL OFFICER, BOARD MEMBER AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SIGNS A STATEMENT ANNUALLY WHICH AFFIRMS THAT PERSON HAS RECEIVED, UNDERSTANDS AND AGREES TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE OFFICERS OF THE CORPORATION SHALL BE ENTITLED TO SUCH REASONABLE COMPENSATION FOR THEIR SERVICES AS IS APPROVED BY THE BOARD OF DIRECTORS AND TO THE REIMBURSEMENT OF REASONABLE EXPENSES, IF ANY, INCURRED BY THEM AS OFFICERS, IF APPROVED BY THE BOARD OF DIRECTORS, AND NOTHING HEREIN SHALL BE CONSTRUED TO PRECLUDE AN OFFICER FROM SERVING THE CORPORATION IN ANY OTHER CAPACITY AND RECEIVING COMPENSATION FOR SUCH OTHER SERVICES. COMPENSATION FOR THE CEO/DENTAL DIRECTOR AND ANY KEY EMPLOYEES OF THE ORGANIZATION ARE DETERMINED BASED ON CURRENT COMPENSATION SURVEYS COMPILED BY AN INDEPENDENT FIRM. COMPENSATION IS APPROVED BY AN OFFICER OF THE ORGANIZATION IN ADVANCE OF PAYMENT. RECORDS OF RELATED SURVEYS AND APPROVALS ARE MAINTAINED IN PERSONNEL FILES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON THE REQUEST OF SUCH DOCUMENTS. FORM 990, PART XI, LINE 9: DIFFERENCE BETWEEN FMV AND BOOK VALUE OF ASSETS DISTRIBUTED AT DISSOLUTION 45,781.