FORM 1023-EZ for ACT CARE FOUNDATION

Field Data
EIN 84-2513949
Case Number EO-2020016-000305
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ACT CARE FOUNDATION
Organization’s Mailing Address 1698 VICTORY BOULEVARD
City STATEN ISLAND
State NY
ZIP 10314
Accounting period End 12
Primary contact name RYAN SELFRIDGE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HEIDI TUCKER
PRESIDENT
47 NEW SCOTLAND AVENUE
ALBANY NY 11208

Officer/Director/Trustee Two

JILLIAN FAISON
VICE PRESIDENT
15 LEAF ROAD
DELMAR NY 12054

Officer/Director/Trustee Three

GINA TESORIERO
SECRETARY
342 LENOX ROAD
BROOKLYN NY 11226

Officer/Director/Trustee Four

RYAN SELFRIDGE
TREASURER
1698 VICTORY BOULEVARD
STATEN ISLAND NY 10314

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/25/2019
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G83 - Alzheimer's Disease
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 RYAN SELFRIDGE
Signature Title TREASURER
Signature Date 1/14/2020

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