FORM 1023-EZ for IMPACT EXPERIENCE

Field Data
EIN 83-1229395
Case Number EO-2020184-000190
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name IMPACT EXPERIENCE
Organization’s Mailing Address 2209 MYRTLEWOODS DRIVE
City GASTONIA
State NC
ZIP 28052
Accounting period End 12
Primary contact name ANNETTE PHILLIPS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANNETTE PHILLIPS
CEO
2209 MYRTLEWOODS DRIVE
GASTONIA NC 28052

Officer/Director/Trustee Two

DEWON PHILLIPS
DIRECTOR
2209 MYRTLEWOODS DRIVE
GASTONIA NC 29052

Officer/Director/Trustee Three

TONIA GRIMES
SECRETARY
1650 CEDAR RIDGE
GASTONIA NC 28052

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2012
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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 Yes
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 ANNETTE PHILLIPS
Signature Title CEO
Signature Date 6/30/2020

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