FORM 1023-EZ for CAROLINA DX FOUNDATION

Field Data
EIN 47-4037742
Case Number EO-2015142-000421
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAROLINA DX FOUNDATION
Organization’s Mailing Address 218 OHENRY AVE/PO BOX 577
City DAVIDSON
State NC
ZIP 28036-0577
Accounting period End 12
Primary contact name JOSEPH WAGONER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

HAROLD BOUTON
PRESIDENT
1831 BOBOLINK LANE
CHARLOTTE NC 28226-5701

Officer/Director/Trustee Two

WILLIAM FISHER
VICE PRESIDENT
2133 KIRKWOOD AVENUE / APT 2
CHARLOTTE NC 28203-5966

Officer/Director/Trustee Three

JOSEPH WAGONER
SECRETARY-TREASURER
218 OHENRY AVENUE
DAVIDSON NC 28036-0577

Organization’s website
Organization’s email JCW53@CORNELL.EDU
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/20/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A34 - Radio
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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 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
Signature Title
Signature Date

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