FORM 1023-EZ for DENTAL PATIENT SAFETY FOUNDATION
| Field | Data |
|---|---|
| EIN | 82-2245000 |
| Case Number | EO-2017208-000369 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | DENTAL PATIENT SAFETY FOUNDATION |
| Organization’s Mailing Address | 16011 SOUTH 108TH AVENUE |
| City | ORLAND PARK |
| State | IL |
| ZIP | 60467 |
| Accounting period End | 6 |
| Primary contact name | ROBERT C BOSACK |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
ROBERT BOSACK
PRESIDENT
16011 SOUTH 108TH AVENUE
ORLAND PARK IL 60467
Officer/Director/Trustee Two
STUART LIEBLICH
TREASURER
34 DALE ROAD
AVON CT 06011
Officer/Director/Trustee Three
MICHAEL ROLLERT
CHAIRPERSON
6850 EAST HAMPDEN AVENUE
DENVER CO 80224
Officer/Director/Trustee Four
ROY STEVENS
DIRECTOR
8283 SOUTH WALKER
OKLAHOMA CITY OK 73139
Officer/Director/Trustee Five
JASON BRADY
DIRECTOR
3343 EAST INDIGO BAY COURT
GILBERT AZ 85234
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 7/11/2017 |
| Organization Incorporation State | IL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | H01 - Alliance/Advocacy Organizations |
| Organization’s purpose | Charitable: No Religious: No Educational: Yes Scientific: No Literary: No Public Safety: Yes 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 | No |
| Benefit of College | No |
| Private Foundation 508(e) | Yes |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | |
| Signature Title | |
| Signature Date |
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