FORM 1023-EZ for DR FRANK HOLSTON BAPTIST MEDICAL AND DENTAL MISSION TEAM INC

Field Data
EIN 20-0079842
Case Number EO-2016083-000403
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DR FRANK HOLSTON BAPTIST MEDICAL AND DENTAL MISSION TEAM INC
Organization’s Mailing Address 333 SOUTH HARKNESS STREET
City JACKSON
State GA
ZIP 30233
Accounting period End 12
Primary contact name DAVID HAISTEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

HENRY BAGBY
CO CHAIR
505 NATHAN THAXTON RD
JACKSON GA 30233

Officer/Director/Trustee Two

BONNIE STANDARD
CO CHAIR
472 NATHAN THAXTON RD
JACKSON GA 30233

Officer/Director/Trustee Three

EMMA CHAPMAN
SEC
156 FAY ST
JACKSON GA 30233

Officer/Director/Trustee Four

DAVID HAISTEN
TREASURER
333 SOUTH HARKNESS ST
JACKSON GA 30233

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/26/2013
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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
Signature Title
Signature Date

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