FORM 1023-EZ for LIBERTY DENTAL PLAN FOUNDATION

Field Data
EIN 46-2781808
Case Number EO-2014283-000195
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIBERTY DENTAL PLAN FOUNDATION
Organization’s Mailing Address 610 NEWPORT CENTER DRIVE SUITE 700
City NEWPORT BEACH
State CA
ZIP 92660
Accounting period End 12
Primary contact name DONALD REGAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN CARVELLI
DIRECTOR PRESIDENT
610 NEWPORT CENTER DR STE 700
NEWPORT BEACH CA 92660-6474

Officer/Director/Trustee Two

DON REGAN
DIRECTOR SECRETARY
610 NEWPORT CENTER DR STE 700
NEWPORT BEACH CA 92660-6474

Organization’s website
Organization’s email DJREGANPC@PRODIGY.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/27/2012
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B99 - Education N.E.C.
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 Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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