FORM 1023-EZ for DAVID T JONKE DDS RECOVERY DENTAL

Field Data
EIN 81-3282785
Case Number EO-2016217-000205
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DAVID T JONKE DDS RECOVERY DENTAL
Organization’s Mailing Address 1540 MADISON AVENUE
City LAKEWOOD
State OH
ZIP 44107
Accounting period End 12
Primary contact name DAVID T JONKE DDS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID JONKE
DIRECTOR
19545 BATTERSEA
ROCKY RIVER OH 44116

Officer/Director/Trustee Two

PATRICK HYLAND
ACCOUNTANT
1583 LINCOLN AVENUE
LAKEWOOD OH 44107

Officer/Director/Trustee Three

ANDREA DIBIASIO
DIRECTOR OF EDNA HOUSE
2007 W 65 STREET
CLVELAND OH 44102

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/2016
Organization Incorporation State OH
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 Yes
One Third Support Gifts No
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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