FORM 1023-EZ for DAVIDSON LIFELINE

Field Data
EIN 46-5647040
Case Number EO-2014220-000122
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DAVIDSON LIFELINE
Organization’s Mailing Address 18658 SHREARER ROAD
City DAVIDSON
State NC
ZIP 28036-9076
Accounting period End 12
Primary contact name LYNN HENNIGHAUSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LYNN HENNIGHAUSEN
PRESIDENT
18658 SHEARER ROAD
DAVIDSON NC 28036-9076

Officer/Director/Trustee Two

LISA HILSE
VICE PRESIDENT
13404 ROBERT WALKER DRIVE
DAVIDSON NC 28036-6007

Officer/Director/Trustee Three

DIANE ELKINS
SECRETARY
18708 GREYTON LANE
DAVIDSON NC 28036-7807

Officer/Director/Trustee Four

LESLIE WILLIS
TREASURER
118 MARTIN STREET
DAVIDSON NC 28036-0137

Organization’s website
Organization’s email LYNNHENN2@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/6/2014
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention N.E.C.
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 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 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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