FORM 1023-EZ for GEORGIA DHI INC

Field Data
EIN 47-3149421
Case Number EO-2015127-000341
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GEORGIA DHI INC
Organization’s Mailing Address 1000 PEACHTREE INDUSTRIAL RD STE6
City SUWANNE
State GA
ZIP 30024
Accounting period End 12
Primary contact name LISA HENDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DEBBIE PURCELL
PRESIDENT
192 ANDERSON CIRCLE
ALTO GA 30510

Officer/Director/Trustee Two

DON BORTORSKI
VICE PRESIDENT
1530 HILLCREST ROAD
NORCROSS GA 30093

Officer/Director/Trustee Three

PATRICK MCQUILLIAM
TREASURER
4501 CIRCLE 75 PKWY SU F6140
ATLANTA GA 30339

Officer/Director/Trustee Four

GRANT TILLMAN
SECRETARY
1530 HILLCREST ROAD
NORCROSS GA 30093

Officer/Director/Trustee Five

LISA HENDERSON
CPA/POWER OF ATTORNEY
804 WASHINGTON STREET NW
GAINESVILLE GA 30501

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/9/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B03 - Professional Societies, Associations
Organization’s purpose Charitable: No
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 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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