FORM 1023-EZ for CARE SPOT ADULT DAY CENTER

Field Data
EIN 81-4628938
Case Number EO-2016347-000230
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CARE SPOT ADULT DAY CENTER
Organization’s Mailing Address 846 POYDRAS LANE N
City JACKSONVILLE
State FL
ZIP 32218
Accounting period End 12
Primary contact name STEPHANIE FORDE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STEPHANIE FORDE
PRESIDENT
846 POYDRAS LANE N
JACKSONVILLE FL 32218

Officer/Director/Trustee Two

ERNEST FORDE
DIRECTOR
846 POYDRAS LANE N
JACKSONVILLE FL 32218

Officer/Director/Trustee Three

JIMMIE GREEN
DIRECTOR
12351 V C JOHNSON RD
JACKSONVILLE FL 32218

Officer/Director/Trustee Four

SANDRA GREEN
DIRECTOR
12351 V C JOHNSON RD
JACKSONVILLE FL 32218

Organization’s website
Organization’s email CARESPOT@ATT.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/8/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, Services
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
Signature Title
Signature Date

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