FORM 1023-EZ for EASE T1D

Field Data
EIN 86-2028798
Case Number EO-2021097-001028
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EASE T1D
Organization’s Mailing Address 1411 RIMPAU AVENUE SUITE 109-1031
City CORONA
State CA
ZIP 92879
Accounting period End 12
Primary contact name SAM MAZZEO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBRA GEORGE
PRESIDENT CEO CHAIRPERSON DIRECTOR
1411 RIMPAU AVENUE SUITE 109-1031
CORONA CA 92879

Officer/Director/Trustee Two

MICHELLE THORNBURG
SECRETARY TREASURER AND DIRECTOR
1411 RIMPAU AVENUE SUITE 109-1031
CORONA CA 92879

Officer/Director/Trustee Three

ERIC ESTES
DIRECTOR
1411 RIMPAU AVENUE SUITE 109-1031
CORONA CA 92879

Officer/Director/Trustee Four

SUSAN GRIFFIN
DIRECTOR
1411 RIMPAU AVENUE SUITE 109-1031
CORONA CA 92879

Officer/Director/Trustee Five

MELODIE SEVILLA
DIRECTOR
1411 RIMPAU AVENUE SUITE 109-1031
CORONA CA 92879

Organization’s website WWW.EASET1D.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/21/2021
Organization Incorporation State CA
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 Yes
Compensation of Officer director trustee Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 DEBRA GEORGE
Signature Title PRESIDENT CEO CHAIRPERSON DIRECTOR
Signature Date 3/16/2021

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