FORM 1023-EZ for ADDI GIVES BACK INC

Field Data
EIN 84-2917107
Case Number EO-2019277-000470
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADDI GIVES BACK INC
Organization’s Mailing Address 855 MISTY HARBOR BOULEVARD
City WOODBINE
State GA
ZIP 31569
Accounting period End 12
Primary contact name TERRI DERKUM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERICA CREWS
PRESIDENT
855 MISTY HARBOR BOULEVARD
WOODBINE FM 31569

Officer/Director/Trustee Two

MALLORY WILSON
SECRETARY
190 LEIGH LANE
WOODBINE GA 31569

Officer/Director/Trustee Three

GREG CREWS
VICE PRESIDENT
855 MISTY HARBOR BOULEVARD
WOODBINE GA 31569

Officer/Director/Trustee Four

PAULA WILSON
TREASURER
855 MISTY HARBOR BOULEVARD
WOODBINE GA 31569

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/2/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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 Yes
Donation of funds Yes
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 ERICA CREWS
Signature Title PRESIDENT
Signature Date 9/30/19

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