SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
COMMUNITY DENTAL CLINIC INC
 
Employer identification number

45-3340613
Return Reference Explanation
FORM 990 - ORGANIZATION'S MISSION THE COMMUNITY DENTAL CLINIC PROVIDES ACCESS TO COMPREHENSIVE AND PREVENTATIVE DENTAL HEALTHCARE THROUGH VOLUNTEERISM AND COMMUNITY PARTNERSHIPS SERVING VERY LOW INCOME ADULTS(STRUGGLING AT 200% AND BELOW THE FEDERAL POVERTY LEVEL) AND DEVELOPMENTALLY DISABLED ADULTS REGARDLESS OF RACE, ETHNICITY, GENDER AND DISABILITY.
FORM 990, PAGE 1, PART I, LINE 6 DENTIST VOLUNTEER TIME AND EXPERTISE FOR CORRECTIVE DENTISTRY PROCEDURES. OTHER VOLUNTEERS PERFORM ADMINISTRATIVE FUNCTIONS; ON FREE DENTAL SCREENING DAYS VARIOUS VOLUNTEERS GUIDE NEW PATIENTS THROUGH A SERIES OF REQUIRED STEPS TO BECOME PATIENTS OF THE CLINIC.
FORM 990, PART VI LINE 19 PROVIDES FINANCIAL INFORMATION, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ON REQUEST. SECTION B. POLICIES LINE 13 - A PLAN IS IN THE PROCESS OF BEING IMPLEMENTED SECTION B POLICIES LINE 14-A PLAN IS IN THE PROCESS OF BEING IMPLEMENTED PART VII, OFFICERS, ETC - ALL OFFICERS, DIRECTORS AND EMPLOYEES RESIDE LOCALLY AND CAN BE REACHED THROUGH THE TREASURER'S OFFICE OR DIRECTLY
FORM 990, PAGE 6, PART VI, LINE 9 ALLISON SAPIEGA 103 ARLINGTON AVENUE EAST OLDSMAR, FL 34677 STEVE HELLER 3117 HARVEST MOON DR PALM HARBOR, FL 34683 C ALLEN KYNES 265 EDGEWATER DRIVE DUNEDIN, FL 34698 JEANNIE SHAPIRO 308 HICKORY LAND LARGO, FL 33756 WILLIAM D LAYMAN DDS DMD 501 S MISSOURI AVE CLEARWATER, FL 33756 ROWLAND MILAM 1828 VENETIAN PT DR CLEARWATER, FL 33755 JAMES PITTS, DMD 102 CARLYLE DR PALM HARBOR, FL 34683 R PAUL UMBERG 210 PINE ROAD BELLEAIR, FL 33756 JAMES R HAYSLETT DDS 2226 DRUID ROAD E CLEARWATER, FL 33764 ELIZABETH J HARVARD 4 BELLEVIEW BLVD, APT 305 BELLEAIR, FL 33756 J HUNTER ORR 3005 SUNSET DRIVE BELLEAIR BLUFFS, FL 37770
FORM 990, PAGE 6, PART VI, LINE 11B PROVIDED COPY TO BOARD MEMBERS FOR COMMENT.
FORM 990, PAGE 6, PART VI, LINE 12C MONTHLY CONFLICT OF INTEREST ON EACH MEETING AGENDA AND RECORDED IN MINUTES; MEETINGS GENERALLY MONTHLY.
FORM 990, PAGE 6, PART VI, LINE 15A DETERMINED BY CHAIR AND SECRETARY WITH KNOWLEDGE OF MARKETPLACE SALARIES; DISCUSSION WITH BOARD MEMBERS AND ULTIMATELY APPROVED BY BOARD VOTE.
FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC
FORM 990, PART IX, LINE 11G DENTAL STAFFING 4,786 0 0 DENTAL SUPPLIES 18,359 0 0 DENTAL ASST 4,104 0 0 TAXES 0 428 0 SECURITY 0 256 85 CLEANING 0 700 0 REPAIRS 0 1,710 0 DENTAL SCREENING DAY EXPENSES 342 0 0 PROFESSIONAL FEES 3,000 0 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

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