FORM 1023-EZ for DIVERSIFIED HEALTHCARE OPTION INC

Field Data
EIN 81-4842584
Case Number EO-2017037-000403
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DIVERSIFIED HEALTHCARE OPTION INC
Organization’s Mailing Address 1385 LAKEBOAT WAY SW
City ATLANTA
State GA
ZIP 30331
Accounting period End 12
Primary contact name MASHA GREEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARSHA GREEN
DIRECTOR
1385 LAKEBOAT WAY SW
ATLANTA GA 30331

Officer/Director/Trustee Two

MICHELLE GREEN
BOARD MEMBER
2611 ANACUA WAY
AUGUSTA GA 30906

Officer/Director/Trustee Three

ANNA BAILEY
BOARD MEMBER
1410 VININGS PARKWAY
SMYRNA GA 30080

Officer/Director/Trustee Four

WINSTON GREEN
BOARD MEMBER
105 HIGHLANDS FOREST LANE
OXFORD GA 30054

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/20/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support 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 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 Yes
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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