FORM 1023-EZ for PREVENTATIVE DENTAL CARE

Field Data
EIN 82-4836857
Case Number EO-2018093-000095
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PREVENTATIVE DENTAL CARE
Organization’s Mailing Address 1785 W HWY 89A SUITE 3F
City SEDONA
State AZ
ZIP 86336
Accounting period End 12
Primary contact name SCOTT HIRSBRUNNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SCOTT HIRSBRUNNER
OFFICER
1785 W HWY 89A STE 3F
SEDONA AZ 86336

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/17/18
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SCOTT HIRSBRUNNER
Signature Title OFFICER
Signature Date 4/1/18

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