FORM 1023-EZ for GLORY SPRINGS URGENT CARE

Field Data
EIN 82-5112236
Case Number EO-2021053-000236
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GLORY SPRINGS URGENT CARE
Organization’s Mailing Address 4504 20TH ST NE
City TUSCALOOSA
State AL
ZIP 35404
Accounting period End 12
Primary contact name DENICE STONE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENICE STONE
OWNER/DIRECTOR/TREASURER/PRESIDENT
1288 COUNTY ROAD 52
GOODWATER AL 35072

Officer/Director/Trustee Two

MARIA CASTRO
SECRETARY
PO BOX 184
HOPEDALE IL 61747

Officer/Director/Trustee Three

RADARIUS FOSTER
DIRECTOR
202 SOUTHWEST RAILROAD STREET
HOPEDALE IL 61747

Officer/Director/Trustee Four

DARRELL FOSTER
DIRECTOR
45980 IS HWY 280
SYLACAUGA AL 35150

Organization’s website
Organization’s email GLORYSPRINGSURGENTCARE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/2020
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 Yes
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 No
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 DENICE STONE
Signature Title OWNER/DIRECTOR/TREASURER/PRESIDENT
Signature Date 12/23/2020

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