FORM 1023-EZ for ARCHDALE COMMUNITY CENTER

Field Data
EIN 84-2852659
Case Number EO-2019277-000965
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ARCHDALE COMMUNITY CENTER
Organization’s Mailing Address 1901 ARCHDALE DRIVE
City CHARLOTTE
State NC
ZIP 28210
Accounting period End 12
Primary contact name DAVID W LISK SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID ORTIGOZA
CHIEF OPERATING OFFICER
401 EDGEGREEN DRIVE
CHARLOTTE NC 28217

Officer/Director/Trustee Two

DOUGLAS DENNISON
TREASURER
7623 RATHBURN LANE
CHARLOTTE NC 28277-254

Officer/Director/Trustee Three

DAVID LISK
CHAIRMAN
14505 BALLANTYNE LAKE ROAD APT 511
CHARLOTTE NC 28277

Officer/Director/Trustee Four

CAROLYN KIER
DIRECTOR
7523 STARVALLEY DRIVE
CHARLOTTE NC 28210-6551

Officer/Director/Trustee Five

GEOFFREY HEMENWAY
DIRECTOR
7700 COVEY CHASE DRIVE
CHARLOTTE NC 28210

Organization’s website
Organization’s email DLISK@RHMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/19
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T31 - Community Foundations
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 GEOFFREY HEMENWAY
Signature Title DIRECTOR
Signature Date 10/2/19

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