FORM 1023-EZ for HOSPITAL DENTISTRY FOR KIDS INC

Field Data
EIN 84-4694174
Case Number EO-2021026-000045
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HOSPITAL DENTISTRY FOR KIDS INC
Organization’s Mailing Address 4980 SOUTH COUNTY ROAD T
City DENMARK
State WI
ZIP 54208-9479
Accounting period End 12
Primary contact name ANGELA GHOLSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CLINT RAU
PRESIDENT
4980 S COUNTY ROAD T
DENMARK WI 54208-9479

Officer/Director/Trustee Two

CARRIE STEMPSKI
VICE PRESIDENT
2829 EAST PENNWOOD CIRCLE
GREEN BAY WI 54301-2850

Officer/Director/Trustee Three

JENNA LINDEN
SECRETARY
600 SOUTH RIDGE LANE
APPLETON WI 54914-4111

Officer/Director/Trustee Four

ANGELA RAU
TREASURER
4980 S COUNTY ROAD T
DENMARK WI 54208-9479

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/5/2019
Organization Incorporation State WI
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 No
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 ANGELA RAU
Signature Title TREASURER
Signature Date 12/7/2020

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