FORM 1023-EZ for EUSTIS COMMUNITY ALLIANCE INC

Field Data
EIN 86-3012984
Case Number EO-2021148-000109
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EUSTIS COMMUNITY ALLIANCE INC
Organization’s Mailing Address 1006 WASHINGTON AVENUE
City EUSTIS
State FL
ZIP 32726
Accounting period End 12
Primary contact name DINA JOHN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DINA JOHN
PRESIDENT
1006 WASHINGTON AVENUE
EUSTIS FL 32726

Officer/Director/Trustee Two

RONALD MUSSELMAN
VP
POST OFFICE BOX 1844
EUSTIS FL 32727

Officer/Director/Trustee Three

LAURENCE ALLENBAUGH
SECRETARY
111 EAST WARD AVENUE
EUSTIS FL 32726

Officer/Director/Trustee Four

THERESA JACKSON
TREASURER
2405 SANDRIDGE CIRCLE
EUSTIS FL 32726

Officer/Director/Trustee Five

KELLY HADLEY
CCO
36511 BARRINGTON DRIVE
EUSTIS FL 32736

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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 DINA JOHN
Signature Title PRESIDENT
Signature Date 5/20/2021

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