FORM 1023-EZ for PATRICK WORRELL MEMORIAL FOUNDATION

Field Data
EIN 86-3556272
Case Number EO-2021172-000571
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PATRICK WORRELL MEMORIAL FOUNDATION
Organization’s Mailing Address PO BOX 101928
City FT WORTH
State TX
ZIP 76185
Accounting period End 12
Primary contact name HEIDI HILLIARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID MANUEL
PRESIDENT & DIRECTOR
11625 NORTHVIEW DRIVE
ALEDO TX 76008

Officer/Director/Trustee Two

HEIDI HILLIARD
TREASURER & DIRECTOR
4309 STONEDALE ROAD
FORT WORTH TX 76116

Officer/Director/Trustee Three

ALLISON RIX
SECRETARY & DIRECTOR
6359 GREENWAY ROAD
FORT WORTH TX 76116

Officer/Director/Trustee Four

CECILIA SILVA
DIRECTOR
3304 AVONDALE AVENUE
FORT WORTH TX 76109

Officer/Director/Trustee Five

WENDE DWYER-JOHNSEN
DIRECTOR
6128 CURZON AVENUE
FORT WORTH TX 76116

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/23/2021
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 DAVID MANUEL
Signature Title PRESIDENT & DIRECTOR
Signature Date 6/18/2021

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