FORM 1023-EZ for SAPPHIRE PERSONAL CARE ASSOCIATES

Field Data
EIN 84-4265271
Case Number EO-2020029-000495
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SAPPHIRE PERSONAL CARE ASSOCIATES
Organization’s Mailing Address 3610 JASMINE COVE LN
City SNELLVILLE
State GA
ZIP 30039
Accounting period End 12
Primary contact name SHANA BURWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHANA BURWELL
OWNER/ADMINISTRATOR
3610 JASMINE COVE LN
SNELLVILLE GA 30039

Officer/Director/Trustee Two

SHANA BURWELL
CFO
3610 JASMINE COVE LN
SNELLVILLE GA 30039

Officer/Director/Trustee Three

SHANA BURWELL
OWNER/ADMINISTRATOR
3610 JASMINE COVE LN
SNELLVILLE GA 30039

Officer/Director/Trustee Four

SHANA BURWELL
OWNER/ADMINISTRATOR
3610 JASMINE COVE LN
SNELLVILLE GA 30039

Officer/Director/Trustee Five

SHANA BURWELL
CFO
3610 JASMINE COVE LN
SNELLVILLE GA 30039

Organization’s website SPCAHEALTHCARE.COM
Organization’s email ADMINISTRATOR@SPCAHEALTHCARE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/2020
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E92 - Home Health Care
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
Conducting Activities Outside of United States Yes
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 SHANA BURWELL
Signature Title CFO
Signature Date 1/27/2020

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