FORM 1023-EZ for EMMA J CLARK MEMORIAL FOUNDATION INC

Field Data
EIN 47-4982821
Case Number EO-2017107-000416
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMMA J CLARK MEMORIAL FOUNDATION INC
Organization’s Mailing Address 5821 HIGHLAND AVE
City RICHMOND
State CA
ZIP 94804
Accounting period End 12
Primary contact name DORIS MANGRUM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EMMA CLARK
CHAIRMAN
5821 HIGHLAND AVE
RICHMOND CA 94804-5013

Officer/Director/Trustee Two

DORIS MANGRUM
PRESIDENT
2445 CROCKER WAY
ANTIOCH CA 94531-8552

Officer/Director/Trustee Three

DORCAS DUFFEY
SECRETARY
1140 REDWOOD ST
PITTSBURG

Officer/Director/Trustee Four

SHIRLEY LEVIAS
VICE PRESIDENT
434 SEAGULL CT
HERCULES

Officer/Director/Trustee Five

LA MIRLDRED MACKABEE-ANDERSON
VICE PRESIDENT
2406 CADY CT
SAN LEANDRO CA 94578-1208

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/15/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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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