FORM 1023-EZ for LIFE A DEMENTIA FRIENDLY FOUNDATION

Field Data
EIN 81-3747283
Case Number EO-2016312-000258
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE A DEMENTIA FRIENDLY FOUNDATION
Organization’s Mailing Address 591 FERNDALE
City VERMILION
State OH
ZIP 44089
Accounting period End 12
Primary contact name CAROLE KLINGLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERRY FRIES-MALOY
PRESIDENT
4537 SUMMER ST
SHEFFIELD OH 44054

Officer/Director/Trustee Two

PHYLLIS SCHOENBERGER
VICE PRESIDENT
36650 CHESTER RD
AVON OH 44011

Officer/Director/Trustee Three

SUSAN WALLACE
TREASURER
10789 DEER RUN
GRAFTON OH 44044

Officer/Director/Trustee Four

MICHELE TARSITANO-AMATO
SECRETARY
17606 HILLIARD
LAKEWOOD OH 44107

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G83 - Alzheimer's Disease
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 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
Signature Title
Signature Date

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