FORM 1023-EZ for ARIZONA FOUNDATION FOR SWALLOWING DISORDERS

Field Data
EIN 46-4233087
Case Number EO-2014233-000250
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ARIZONA FOUNDATION FOR SWALLOWING DISORDERS
Organization’s Mailing Address 6929 N HAYDEN RD SUITE C-4 -189
City SCOTTSDALE
State AZ
ZIP 85250-7970
Accounting period End 12
Primary contact name KAREN PITICO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KAREN PITICO
PRESIDENT
6929 N HAYDEN RD ST C-4 /189
SCOTTSDALE AZ 85250-7970

Officer/Director/Trustee Two

DON NEWMAN
BOARD MEMBER
7330 NORTH 16TH ST C-117
PHOENIX AZ 85020-5237

Organization’s website WWW.AFFSD.ORG
Organization’s email AFFSD,INFO@COX.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2013
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G80 - Specifically Named Diseases
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 Yes
One Third Support Gifts No
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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