FORM 1023-EZ for DREAM CENTER DENTAL CLINICS FOUNDATION

Field Data
EIN 84-2388567
Case Number EO-2019198-000136
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DREAM CENTER DENTAL CLINICS FOUNDATION
Organization’s Mailing Address 15310 W EVANS DRIVE
City SURPRISE
State AZ
ZIP 85379
Accounting period End 12
Primary contact name KEVIN COVINGTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEVIN COVINGTON
PRESIDENT
15310 W EVANS DR
SURPRISE AZ 85379

Officer/Director/Trustee Two

RICHARD HALL KEEFER
SECRETARY
11239 N 11TH PLACE
PHOENIX AZ 85020

Officer/Director/Trustee Three

CHRIS MORRIS
TREASURER
11209 N 161ST LN
SURPRISE AZ 85379

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/1/19
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 KEVIN COVINGTON
Signature Title PRESIDENT
Signature Date 7/15/19

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