FORM 1023-EZ for ST AUGUSTINE DENTAL SOCIETY INCORPORATED

Field Data
EIN 81-0786135
Case Number EO-2020195-000214
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ST AUGUSTINE DENTAL SOCIETY INCORPORATED
Organization’s Mailing Address 17 ENREDE LANE
City ST AUGUSTINE
State FL
ZIP 32095
Accounting period End 12
Primary contact name ATTORNEY JOHN SPENCE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CRAIG HADGIS
PRESIDENT
17 ENREDE LANE
ST AUGUSTINE FL 32095

Officer/Director/Trustee Two

MICHAEL ROMANI
TREASURE
10 SAINT JOHNS MEDICAL PARK DRIVE C
ST. AUGUSTINE FL 32086

Officer/Director/Trustee Three

JEREMY GORDON
SECRETARY
300 PLANTATION ISLAND DRIVE
ST. AUGUSTINE FL 32084

Officer/Director/Trustee Four

RON DIXON
PAST PRESIDENT
514 ELEVENTH STREET
ST. AUGUSTINE FL 32084

Officer/Director/Trustee Five

MATT MCLELLAN
PAST TREASURER
1110-2 S PONCE DE LEON
ST AUGUSTINE FL 32084

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E03 - Professional Societies, Associations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CRAIG HADGIS
Signature Title PRESIDENT
Signature Date 6/8/2020

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