FORM 1023-EZ for GRANITE STATE DENTAL PROGRAM
| Field | Data |
|---|---|
| EIN | 82-4495969 |
| Case Number | EO-2018057-000295 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | GRANITE STATE DENTAL PROGRAM |
| Organization’s Mailing Address | 166 PLAISTOW ROAD |
| City | PLAISTOW |
| State | NH |
| ZIP | 3865 |
| Accounting period End | 12 |
| Primary contact name | MEG HORAN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
ANGELA ESTES
EXECUTIVE DIRECTOR
166 PLAISTOW ROAD
PLAISTOW NH 3865
Officer/Director/Trustee Two
DEBRA FILOCOMA
CHAIRMAN
166 PLAISTOW ROAD
PLAISTOW NH 3865
Officer/Director/Trustee Three
MELISSA DENNISON NEWMAN
ASSISTANT SECRETARY
166 PLAISTOW ROAD
PLAISTOW NH 3865
Officer/Director/Trustee Four
MEG HORAN
SECRETARY/TREASURER
166 PLAISTOW ROAD
PLAISTOW NH 3865
Officer/Director/Trustee Five
SUSAN RACICOT
VOTING BOARD MEMBER
166 PLAISTOW ROAD
PLAISTOW NH 3865
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/31/18 |
| Organization Incorporation State | NH |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E70 - Public Health Program (Includes General Health and Wellness Promotion 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 | DEBRA FILOCOMA |
| Signature Title | CHAIRMAN |
| Signature Date | 2/22/18 |
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