FORM 1023-EZ for NIKODEM DENTAL CARE FOUNDATION

Field Data
EIN 82-3997126
Case Number EO-2020224-000200
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NIKODEM DENTAL CARE FOUNDATION
Organization’s Mailing Address 4337 BUTLER HILL RD STE G
City SAINT LOUIS
State MO
ZIP 63128
Accounting period End 12
Primary contact name RAYMOND G NIKODEM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RAYMOND NIKODEM
PRESIDENT
2703 WYNNCREST MANOR DR
CHESTERFIELD MO 63005

Officer/Director/Trustee Two

BRANDI PAUL
OFFICER
906 NANCY DRIVE
OFALLON IL 62269

Officer/Director/Trustee Three

SUZANNE KOZLOWSKI
OFFICER
2630 ANTLER CT
IMPERIAL MO 63052

Officer/Director/Trustee Four

AMANDA HOFFMANN
OFFICER
1220 HOFFMANN EST
COLUMBIA IL 62236

Officer/Director/Trustee Five

KERENSIA BLACKMAN
OFFICER
1760 BAYBERRY LANE
BARNHART MO 63012

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/2/2018
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E50 - Rehabilitative Medical Services
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 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 Yes
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 RAYMOND NIKODEM
Signature Title PRESIDENT
Signature Date 8/6/2020

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