FORM 1023-EZ for BRIGHTER SMILES OF TAMPA BAY INC

Field Data
EIN 86-3003926
Case Number EO-2021123-000460
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BRIGHTER SMILES OF TAMPA BAY INC
Organization’s Mailing Address 4119 APPLE BLOSSOM RD
City LUTZ
State FL
ZIP 33558
Accounting period End 1
Primary contact name ILVANA MEDINA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARLOS MEDINA
COO
4119 APPLE BLOSSOM RD
LUTZ FL 33558

Officer/Director/Trustee Two

ILVANA MEDINA
CFO
4119 APPLE BLOSSOM RD
LUTZ FL 33558

Organization’s website
Organization’s email ILVANAM85@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G12 - 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 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 ILVANA MEDINA
Signature Title CFO
Signature Date 4/30/2021

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