FORM 1023-EZ for MEDINA COUNTY SENIOR AND ADULT FOUNDATION

Field Data
EIN 83-2697026
Case Number EO-2019190-000290
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MEDINA COUNTY SENIOR AND ADULT FOUNDATION
Organization’s Mailing Address 246 NORTHLAND DRIVE SUITE 20
City MEDINA
State OH
ZIP 44256
Accounting period End 12
Primary contact name MARIE EDMONDS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARIE EDMONDS
CHAIR
807 E WASHINGTON ST SUITE 200
MEDINA OH 44256

Officer/Director/Trustee Two

SALLY ALBRECHT
SECRETARY
3017 BLUE HERON TRACE
MEDINA OH 44256

Officer/Director/Trustee Three

MARK GRISKO
TREASURER
3227 COUNTRY CLUB DR
MEDINA OH 44256

Officer/Director/Trustee Four

DEBORAH POLAND
VICE PRESIDENT
3000 PIONEER WAY
MEDINA OH 44256

Officer/Director/Trustee Five

GWEN PERRY
BOARD MEMBER
7530 LUCERNE DR SUITE 200
MIDDLEBURG HEIGHTS OH 44130

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/16
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 MARIE EDMONDS
Signature Title CHAIR
Signature Date 7/5/19

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