FORM 1023-EZ for THE PINELLAS CAREGIVER FOUNDATION LLC

Field Data
EIN 83-3710624
Case Number EO-2019058-000367
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE PINELLAS CAREGIVER FOUNDATION LLC
Organization’s Mailing Address 611 DRUID RD E SUITE 715
City CLEARWATER
State FL
ZIP 33756
Accounting period End 12
Primary contact name JOSEPH MICHAEL DUMBRELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSEPH M DUMBRELL
PRESIDENT
611 DRUID RD E SUITE 715
CLEARWATER FL 33756-3932

Officer/Director/Trustee Two

NIA MCLEOD
VICE PRESIDENT
513 LINCOLN AVENUE
TARPON SPRINGS FL 34689

Officer/Director/Trustee Three

MYRTLE R CLARK
SECRETARY
668 HAVEN PLACE
TARPON SPRINGS FL 34689

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/13/19
Organization Incorporation State FL
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 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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JOSEPH M DUMBRELL
Signature Title PRESIDENT
Signature Date 2/25/19

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