FORM 1023-EZ for DBSACONCORD

Field Data
EIN 90-0488271
Case Number EO-2019053-000185
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DBSACONCORD
Organization’s Mailing Address 33 CARTER ST
City CONCORD
State NH
ZIP 3301
Accounting period End 12
Primary contact name SUSAN V MILLIKEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN MILLIKEN
PRESIDENT
33 CARTER ST
CONCORD NH 3301

Officer/Director/Trustee Two

JAMES MILLIKEN
TREASURER
33 CARTER ST
CONCORD NH 3301

Officer/Director/Trustee Three

STEVE FARR
SECRETARY
15 GREAT FALLS DRIVE
PENACOOK NH 3303

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/20/08
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F70 - Mental Health Disorders
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 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 Yes
Correctness Declaration Yes
Signature Name SUSAN MILLIKEN
Signature Title PRESIDENT
Signature Date 2/20/19

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