FORM 1023-EZ for ATHENS DRIVE HEALTH ALLIANCE

Field Data
EIN 37-1838657
Case Number EO-2016334-000099
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ATHENS DRIVE HEALTH ALLIANCE
Organization’s Mailing Address 1420 ATHENS DRIVE
City RALEIGH
State NC
ZIP 27606-2427
Accounting period End 12
Primary contact name JENNIFER HULSEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SETH TABB
MD- CHAIR
1400 CRESENT GREEN SUITE 120
CARY NC 27518

Officer/Director/Trustee Two

JENNIFER HULSEY
DIR OF HEALTH SCIENCE ACADEMY
1420 ATHENS DRIVE
RALEIGH NC 27606

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/14/2016
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 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
Signature Title
Signature Date

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