FORM 1023-EZ for CAROLINA FOUNDATION FOR ORAL HEALTH

Field Data
EIN 56-1795040
Case Number EO-2014287-000194
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAROLINA FOUNDATION FOR ORAL HEALTH
Organization’s Mailing Address 155 RIPPLEWATER LN
City MOORESVILLE
State NC
ZIP 28117-8601
Accounting period End 12
Primary contact name DR RICHARD OLSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DONNA OLSEN
PRESIDENT, TREASURER
155 RIPPLEWATER LN
MOORESVILLE NC 28117-8601

Officer/Director/Trustee Two

RICHARD OLSEN
VICE PRESIDENT, SECRETARY
155 RIPPLEWATER LN
MOORESVILLE NC 28117-8601

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/16/1997
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G80 - Specifically Named Diseases
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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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