FORM 1023-EZ for AVA COMMUNITY DENTAL INC

Field Data
EIN 85-2255335
Case Number EO-2020296-000280
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AVA COMMUNITY DENTAL INC
Organization’s Mailing Address 3350 YORBA LINDA BLVD
City FULLERTON
State CA
ZIP 92831
Accounting period End 7
Primary contact name RONALD F SAWZAK EA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SAEED MOKHAYERI
CEO
3350 YORBA LINDA BLVD
FULLERTON CA 92831

Officer/Director/Trustee Two

HENGAMEH SAFARCHERATI
SECRETARY
3350 YORBA LINDA BLVD
FULLERTON CA 92831

Officer/Director/Trustee Three

HENGAMEH SAFARCHERATI
TREASURER
3350 YORBA LINDA BLVD
FULLERTON CA 92831

Organization’s website
Organization’s email SAEEDM747@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/4/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 SAEED MOKHAYERI
Signature Title CEO
Signature Date 10/17/2020

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