FORM 1023-EZ for TUMBLEWEED ADULT CARE INC

Field Data
EIN 84-1623241
Case Number EO-2016314-000178
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TUMBLEWEED ADULT CARE INC
Organization’s Mailing Address 1721 RENEE DR
City HURST
State TX
ZIP 76054-3727
Accounting period End 12
Primary contact name DAVID HOLT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CALVITA GRAHAM
ENROLLED AGENT BOARD MEMBER
7610 EMERALD DR
WEST MELBOURNE FL 32904

Officer/Director/Trustee Two

CHRISTOPER POUGH
DOCTOR BOARD MEMBER
2255 ARKANSAS LN NO-2302
GRAND PRARIE TX 75052

Officer/Director/Trustee Three

RICHARD ADAMS
ASSIST PASTOR BOARD MEMBER
9041 RIVER TRAILS BLVD
FORT WORTH TX 76118

Officer/Director/Trustee Four

NIKITA TOPPIN
GRANT-WRITER BOARD MEMBER
3990 VITRUVIAN WAY NO-555
ADDISON TX 75001

Officer/Director/Trustee Five

DAVID HOLT
PRESIDENT - DIRECTOR
1721 RENEE DR
HURST TX 76054-3727

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/19/2002
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P81 - Senior Centers, Services
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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