FORM 1023-EZ for SMILE FOR BROOKLYN INC

Field Data
EIN 81-1336985
Case Number EO-2016042-000127
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SMILE FOR BROOKLYN INC
Organization’s Mailing Address 907 WATERVIEW LANE
City ERLANGER
State KY
ZIP 41018
Accounting period End 12
Primary contact name MATTHEW C SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SCOTT SMITH
PRESIDENT/DIRECTOR
907 WATERVIEW LANE
ERLANGER KY 41018

Officer/Director/Trustee Two

EMILY LEDFORD
VICE PRESIDENT/DIRECTOR
7718 MOSS COURT
CINCINNATI OH 45236

Officer/Director/Trustee Three

LYNN MOKROVICH
SECRETARY/DIRECTOR
971 WOODSEDGE DRIVE
ERLANGER KY 41018

Officer/Director/Trustee Four

GRANT NOLTE
TREASURER/DIRECTOR
173 BLACKGOLD COURT
WALTON KY 41094

Officer/Director/Trustee Five

MATTHEW EILERS
DIRECTOR
7310 TURFWAY ROAD SUITE 200
FLORENCE KY 41042

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/2016
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
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
Signature Title
Signature Date

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