FORM 1023-EZ for YOUNG AT HEART ASSISTED LIVING CAREINC

Field Data
EIN 47-2170253
Case Number EO-2017086-000510
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name YOUNG AT HEART ASSISTED LIVING CAREINC
Organization’s Mailing Address 207-B SHELTON BEACH ROAD
City SARALAND
State AL
ZIP 36571
Accounting period End 12
Primary contact name JOROSALYN EDWARDS-FANTROY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOROSALYN EDWARDS-FANTROY
PRESIDENT
207-B SHELTON BEACH ROAD
SARALAND AL 36571

Officer/Director/Trustee Two

ROYDRICK FANTROY
VICE PRESIDENT
207-B SHELTON BEACH ROAD
SARALAND AL 36571

Officer/Director/Trustee Three

DARLENE PACKER
SECRETARY/TREASURER
5889 SPYGLASS DRIVE
MOBILE AL 36619

Officer/Director/Trustee Four

FELICIA PERRY
DIRECTOR
207-B SHELTON BEACH ROAD
SARALAND AL 36571

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/24/2017
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F33 - Group Home, Residential Treatment Facility - Mental Health Related
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 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
Signature Title
Signature Date

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