FORM 1023-EZ for AMITIE - A MEMORIAL FOUNDATION FORSUICIDE PREVENTION

Field	Data
EIN	81-4077757
Case Number	EO-2019045-000218
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	AMITIE - A MEMORIAL FOUNDATION FORSUICIDE PREVENTION
Organization’s Mailing Address	1400 WISTERIA DRIVE
City	METAIRIE
State	LA
ZIP	70005
Accounting period End	12
Primary contact name	REGINA G GRAFF
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00

Officer/Director/Trustee One

REGINA GRAFF
PRESIDENT
1400 WISTERIA DRIVE
METAIRIE LA 70005

Officer/Director/Trustee Two

STACI SCALLON
VICE PRESIDENT
1024 WHITETAIL DRIVE
MANDEVILLE LA 70448

Officer/Director/Trustee Three

JESSICA ERVIN
SECRETARY
61360 AUTUMN RIDGE DRIVE
LACOMBE LA 70445

Officer/Director/Trustee Four

SUSANNE HENDERSON
TREASURER
16309 E BREWSTER ROAD APT J170
COVINGTON LA 70433

Officer/Director/Trustee Five

KRISTEN PUNCH
BOARD MEMBER
1442 FOX COURT
MANDEVILLE LA 70448

Organization’s website	HTTP://AMITIESUICIDEPREVENTION.ORG/
Organization’s email	CONTACTUS@AMITIESUICIDEPREFENTION.ORG
Organization Incorporated	Yes
Organization trust	No
Necessary Organizing Documents	Yes
Organization Incorporation Date	1/15/19
Organization Incorporation State	LA
Contains Limitation	Yes
Does not expressly empower	Yes
Contains dissolution	Yes
National Taxonomy of Exempt Entities (NTEE) code	F60 - Counseling, Support Groups
Organization’s purpose	Charitable: Yes 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	Yes
Conducting Activities Outside of United States	No
Financial transactions with officers	No
Unrelated Gross Income $1,000 or More	No
Gaming Activity	Yes
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	REGINA GRAFF
Signature Title	PRESIDENT
Signature Date	2/12/19
EIN	81-4077757
Case Number	EO-2019045-000218
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	AMITIE - A MEMORIAL FOUNDATION FOR SUICIDE PREVENTION
Organization’s Mailing Address	1400 WISTERIA DRIVE
City	METAIRIE
State	LA
ZIP	70005
Accounting period End	12
Primary contact name	REGINA G GRAFF
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00