FORM 1023-EZ for ST JUDES DENTAL COOPERATIVE

Field Data
EIN 47-5318809
Case Number EO-2015293-000089
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ST JUDES DENTAL COOPERATIVE
Organization’s Mailing Address 591 OAK RIDGE DRIVE
City SIDNEY
State OH
ZIP 45365
Accounting period End 12
Primary contact name LISA ALVETRO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LISA ALVETRO
PRESIDENT
591 OAK RIDGE DRIVE
SIDNEY OH 45365

Officer/Director/Trustee Two

KATHRYN ROSSMAN
DIRECTOR
2484 HEATHER GLEN DRIVE
BEAVERCREEK OH 45431

Officer/Director/Trustee Three

DARLA BOWLING
DIRECTOR
5220 CECIL ROAD
SIDNEY OH 45365

Officer/Director/Trustee Four

TERRY ALLEMANG
DIRECTOR
1487 WEST MAIN STREET
TIPP CITY OH 45371

Officer/Director/Trustee Five

MARISA COUCHOT
DIRECTOR
405 CHARLES AVENUE
SIDNEY OH 45365

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/5/2015
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
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 Yes
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 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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