FORM 1023-EZ for DAVID W ETHRIDGE FUND FOR DEMENTIACAREGIVERS INC

Field Data
EIN 86-1450491
Case Number EO-2021081-000579
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DAVID W ETHRIDGE FUND FOR DEMENTIACAREGIVERS INC
Organization’s Mailing Address 113 BRIDGEWATER DR
City PEACHTREE CITY
State GA
ZIP 30269
Accounting period End 12
Primary contact name CHRISTIE DIEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTIE DIEZ
PRESIDENT, DIRECTOR
3005 PEACHTREE RD NE STE 307
ATLANTA GA 30305

Officer/Director/Trustee Two

ANGELA HOLGUIN
TREASURER, DIRECTOR
148 MAPLE GROVE TER
PEACHTREE CITY GA 30269

Officer/Director/Trustee Three

ROSEMARY MCGEE
DIRECTOR
1717 N DECATUR RD STE 120
ATLANTA GA 30307

Officer/Director/Trustee Four

KATHY ETHRIDGE
DIRECTOR
113 BRIDGEWATER DR
PEACHTREE CITY GA 30269

Officer/Director/Trustee Five

LEXIE WRAY
SECRETARY, DIRECTOR
207 NELLIEFIELD CREEK DR
CHARLESTON SC 29492

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/6/2021
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: Yes
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 CHRISTIE DIEZ
Signature Title PRESIDENT, DIRECTOR
Signature Date 1/27/2021

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