FORM 1023-EZ for LOMA LINDA FRIENDS OF PEDIATRIC DENTISTRY

Field Data
EIN 47-2857965
Case Number EO-2015064-000246
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LOMA LINDA FRIENDS OF PEDIATRIC DENTISTRY
Organization’s Mailing Address 45 DONOVAN
City IRVINE
State CA
ZIP 92620-3882
Accounting period End 12
Primary contact name DANIELLE OSK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DANIEL LEE
CEO/PRESIDENT
45 DONOVAN
IRVINE CA 92620-3882

Officer/Director/Trustee Two

AUDREY SHEU
TREASURER
45 DONOVAN
IRVINE CA 92620-3882

Officer/Director/Trustee Three

MERVIN ELLSTROM
CHAIRMAN OF THE BOARD
45 DONOVAN
IRVINE CA 92620-3882

Officer/Director/Trustee Four

LAURA MCCORMACK
SECRETARY
45 DONOVAN
IRVINE CA 92620-3882

Officer/Director/Trustee Five

KEVIN HSZIEH
VICE PRESIDENT
45 DONOVAN
IRVINE CA 92620-3882

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/4/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B84 - Alumni Associations
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
Signature Title
Signature Date

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