FORM 1023-EZ for WITH C A R E INC

Field Data
EIN 38-4004512
Case Number EO-2016159-000249
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WITH C A R E INC
Organization’s Mailing Address 104 TREEHOUSE PKWY
City NORCROSS
State GA
ZIP 30093
Accounting period End 12
Primary contact name LORNESHIA MOORE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LORNESHIA MOORE
PRESIDENT, DIRECTOR
104 TREEHOUSE PKWY
NORCROSS GA 30093

Officer/Director/Trustee Two

JEFFERY ALLEN JR
SECRETARY, DIRECTOR
6342 KLONDIKE RIVER RD
LITHONIA GA 30083

Officer/Director/Trustee Three

TISEAN SIMMONS
TREASURER, DIRECTOR
6875 PEACHTREE-DUNWOODY
ATLANTA GA 30328

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/25/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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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