FORM 1023-EZ for THAI SMILES INC

Field Data
EIN 82-2361498
Case Number EO-2017216-000269
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THAI SMILES INC
Organization’s Mailing Address 950 HOSPITAL WAY SUITE B
City POCATELLO
State ID
ZIP 83201
Accounting period End 12
Primary contact name BRYCE LARSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRYCE LARSEN
DIRECTOR
950 HOSPITAL WAY SUITE B
POCATELLO ID 83201

Officer/Director/Trustee Two

TIM KITLEY
DIRECTOR
415 TRAUBE AVENUE
CLARENDON HILLS IL 60514

Officer/Director/Trustee Three

MARWA ABULHASAN
DIRECTOR
BLOCK 3 STREET 4 HOUSE 44
BAYAN KUWAIT

Officer/Director/Trustee Four

ROTJANEE DAPHNE LARSEN
DIRECTOR
1416 COTTAGE AVENUE
POCATELLO ID 83201

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/28/2017
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G70 - Digestive Diseases, Disorders
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 Yes
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
Signature Title
Signature Date

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