FORM 1023-EZ for LIFE WITH DIGNITY OBRA 93 POOLED TRUST GENERAL FUND SUB-ACCOUNT
| Field | Data |
|---|---|
| EIN | 47-4688315 |
| Case Number | EO-2018128-000965 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | LIFE WITH DIGNITY OBRA 93 POOLED TRUST GENERAL FUND SUB-ACCOUNT |
| Organization’s Mailing Address | 3780 18TH AVENUE |
| City | ROCK ISLAND |
| State | IL |
| ZIP | 61201 |
| Accounting period End | 12 |
| Primary contact name | GRISHMA PATEL |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
AMERICAN BANK AND TRUST COMPANY NA
TRUSTEE
3780 18TH AVENUE
ROCK ISLAND IL 61201
| Organization’s website | |
|---|---|
| Organization’s email | GPATEL@AMBANKQC.COM |
| Organization Incorporated | |
| Organization trust | Yes |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 7/17/12 |
| Organization Incorporation State | IL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P80 - Services to Promote the Independence of Specific Populations |
| 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 | 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 | Yes |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | AMERICAN BANK AND TRUST COMPANY NA |
| Signature Title | TRUSTEE |
| Signature Date | 5/3/18 |
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