FORM 1023-EZ for POSITIVE INPUT AND CHANGE INC
| Field | Data |
|---|---|
| EIN | 81-0935926 |
| Case Number | EO-2021049-000295 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | POSITIVE INPUT AND CHANGE INC |
| Organization’s Mailing Address | 4525 PINE ISLAND ROAD STE 2 |
| City | SUNRISE |
| State | FL |
| ZIP | 33309 |
| Accounting period End | 12 |
| Primary contact name | WILLIAM GRAYSON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
WILLIAM GRAYSON
PRESIDENT
4525 PINE ISLAND ROAD STE 2
SUNRISE FL 33309
Officer/Director/Trustee Two
RODGER MOBLES
TREASURER
3681 NW 33RD STREET
LAUDERDALE LAKES FL 33309
Officer/Director/Trustee Three
RAIMONDA GUGLIOTTA
SECRETARY
819 N HIGHLAND DRIVE
HOLLYWOOD FL 33021
Officer/Director/Trustee Four
PASTOR GREG
DIRECTOR
524 NW 22ND AVE
FORT LAUDERDALE FL 33311
Officer/Director/Trustee Five
EVE SURDIN
DIRECTOR
1230 NE 16TH PLACE STE 2
FORT LAUDERDALE FL 33305
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 2/9/2016 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P99 - Human Services - Multipurpose and Other N.E.C. |
| 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 | 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 | Yes |
| One Third Support Gifts | No |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | Yes |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | WILLIAM GRAYSON |
| Signature Title | PRESIDENT |
| Signature Date | 12/10/2020 |
| EIN | 81-0935926 |
| Case Number | EO-2015365-000323 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | POSITIVE INPUT AND CHANGE INC |
| Organization’s Mailing Address | 3681 NW 33RD STREET |
| City | LAUDERDALE LAKES |
| State | FL |
| ZIP | 33309 |
| Accounting period End | 12 |
| Primary contact name | WILLIAM GRAYSON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $400.00 |
Officer/Director/Trustee One
WILLIAM GRAYSON
PRESIDENT
3681 NW 33RD STREET
LAUDERDALE LAKES FL 33309
Officer/Director/Trustee Two
NAOMI FABRICANT
TREASURER
3681 NW 33RD STREET
LAUDERDALE LAKES FL 33309
Officer/Director/Trustee Three
ROGER MOBLEY
VICE PRESIDENT
3681 NW 33RD STREET
LAUDERDALE LAKES FL 33309
Officer/Director/Trustee Four
ROBIN WEST
BOARD MEMBER
3681 NW 33RD STREET
LAUDERDALE LAKES FL 33309
| Organization’s website | |
|---|---|
| Organization’s email | WILLIAMGRAYSON49@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 11/20/2015 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | F30 - Mental Health Treatment - Multipurpose and N.E.C. |
| Organization’s purpose | Charitable: Yes Religious: Yes 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 | 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 | Yes |
| One Third Support Gifts | No |
| 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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