FORM 1023-EZ for SERVING SMILES

Field Data
EIN 83-1699670
Case Number EO-2018253-000516
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SERVING SMILES
Organization’s Mailing Address 942 FOREST DALE ROAD
City NEW BRIGHTON
State MN
ZIP 55112
Accounting period End 12
Primary contact name TAMARA BLOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAREN GULLIVER
CHAIR OF BOARD
942 FOREST DALE ROAD
NEW BRIGHTON MN 55112

Officer/Director/Trustee Two

JOANNA BURGESS
BOARD MEMBER
5528 CUMBERLAND ROAD
MINNEAPOLIS MN 55410

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/13/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KAREN GULLIVER
Signature Title CHAIR OF BOARD
Signature Date 9/8/18

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