FORM 1023-EZ for EXPERIENCES FOUNDATION INC

Field Data
EIN 83-1378150
Case Number EO-2018225-000203
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EXPERIENCES FOUNDATION INC
Organization’s Mailing Address 679 LORIMORE PASS
City CANTON
State GA
ZIP 30115
Accounting period End 12
Primary contact name ROBERT BLAKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT BLAKE
PRESIDENT, DIRECTOR
679 LORIMORE PASS
CANTON GA 30115

Officer/Director/Trustee Two

MICHELE BOONE-PINEDA
SECRETARY, DIRECTOR
701 BERKELEY TER
CANTON GA 30115

Officer/Director/Trustee Three

ELIZABETH RUCKER
TREASURER, DIRECTOR
12660 ARNOLD MILL RD
ALPHARETTA GA 30004

Officer/Director/Trustee Four

DONNA MINCEY
DIRECTOR
205 LYNN DR NW
ROME GA 30165

Officer/Director/Trustee Five

CHERYL BLAKE
VICE PRESIDENT, DIRECTOR
679 LORIMORE PASS
CANTON GA 30115

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/20/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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 ROBERT BLAKE
Signature Title PRESIDENT, DIRECTOR
Signature Date 8/9/18

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