FORM 1023-EZ for LEGENDARY SMILES INC

Field Data
EIN 84-4447648
Case Number EO-2021088-000468
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LEGENDARY SMILES INC
Organization’s Mailing Address 973 W 400 S
City KOKOMO
State IN
ZIP 46902
Accounting period End 12
Primary contact name JASON BUSH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MONICA BUSH
EXECUTIVE DIRECTOR
973 W 400 S
KOKOMO IN 46902

Officer/Director/Trustee Two

JASON BUSH
DIRECTOR
973 W 400 S
KOKOMO IN 46902

Organization’s website WWW.LEGENDARYSMILES.ORG
Organization’s email MONICA@LEGENDARYSMILES.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/27/2020
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G90 - Medical Disciplines
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 Yes
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 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 JASON BUSH
Signature Title DIRECTOR
Signature Date 2/9/2021

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