FORM 1023-EZ for DENTAL MENTAL NETWORK INC

Field Data
EIN 84-3529968
Case Number EO-2020013-000273
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DENTAL MENTAL NETWORK INC
Organization’s Mailing Address 305 HIGH ST
City ORIENTAL
State NC
ZIP 28571
Accounting period End 12
Primary contact name SUSAN JEFFRIES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SANDRA HOLIFIELD
DIRECTOR/PRESIDENT
6152 HWY 61
BLOOMSDALE MO 63627

Officer/Director/Trustee Two

CARLOS RODRIGUEZ
DIRECTOR/VICE-PRESIDENT
1228 POST HORN RUN
LAWRENCEVILLE GA 30045

Officer/Director/Trustee Three

SUSAN JEFFRIES
DIRECTOR/TREASURER
305 HIGH ST
ORIENTAL NC 28571

Officer/Director/Trustee Four

VALERIE SEGER
DIRECTOR/SECRETARY
302 GREENGATE CT
WESTMINSTER MD 21158

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/7/2019
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
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 Yes
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 SUSAN JEFFRIES
Signature Title DIRECTOR/TREASURER
Signature Date 1/9/2020

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