FORM 1023-EZ for FAMILY DENTAL CO-PAY RELIEF FUND INC

Field Data
EIN 80-0724099
Case Number EO-2018145-000676
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY DENTAL CO-PAY RELIEF FUND INC
Organization’s Mailing Address 13778 HAWTHORNE BLVD
City HAWTHORNE
State CA
ZIP 90250
Accounting period End 12
Primary contact name JAKE L SHEIKH EA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAKE SHEIKH
TREASURER
13778 HAWTHORNE BLVD
HAWTHORNE CA 90250-7010

Officer/Director/Trustee Two

ROSA FRANCO
PRESIDENT
1365 FRAGRANT SPRUCE DR
LAS VEGAS NV 89123

Officer/Director/Trustee Three

ELENA ARMENDAREZ
CORP SECRETARY
1365 FRAGRANT SPRUCE DR
LAS VEGAS NV 89123

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/11
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 No
Correctness Declaration Yes
Signature Name ROSA FRANCO
Signature Title PRESIDENT
Signature Date 5/23/18

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