FORM 1023-EZ for QUALITY SMILE RESTORERS INC

Field Data
EIN 84-3118620
Case Number EO-2020044-000253
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name QUALITY SMILE RESTORERS INC
Organization’s Mailing Address 7664 WOODLAWN DR UNIT 3
City MOUNDS VIEW
State MN
ZIP 55112
Accounting period End 12
Primary contact name MARIE ADEBIYI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARIE ADEBIYI
PRESIDENT
7664 WOODLAWN DR UNIT 3
MOUNDS VIEW MN 55112

Officer/Director/Trustee Two

BRENDA UWERA
SECRETARY
7664 WOODLAWN DR UNIT 3
MOUNDS VIEW MN 55112

Officer/Director/Trustee Three

DOROTHY MICHORI
TREASURER
7664 WOODLAWN DR UNIT 3
MOUNDS VIEW MN 55112

Officer/Director/Trustee Four

ADEWALE ADEBIYI
BOARD MEMBER
7664 WOODLAWN DR UNIT 3
MOUNDS VIEW MN 55112

Officer/Director/Trustee Five

SHIELA BIFE
BOARD MEMBER
7664 WOODLAWN DR UNIT 3
MOUNDS VIEW MN 55112

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/2019
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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 MARIE ADEBIYI
Signature Title PRESIDENT
Signature Date 2/11/2020

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