FORM 1023-EZ for CONNECTED MENTORING PROGRAM LIMITED

Field Data
EIN 81-2969820
Case Number EO-2018295-000323
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONNECTED MENTORING PROGRAM LIMITED
Organization’s Mailing Address 5450 STAGECOACH ROAD
City ELLENWOOD
State GA
ZIP 30294
Accounting period End 12
Primary contact name CARLTON MATHIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARLTON MATHIS
PRESIDENT
5450 STAGECOACH ROAD
ELLENWOOD GA 30294

Officer/Director/Trustee Two

TELIS JUSTICE
TREASURER
4347 CHESNUT LAKE AVE
LITHONIA GA 30038

Officer/Director/Trustee Three

JENAE CARLISLE
SECRETARY
2550 PLYMOUTH WAY
CONYERS GA 30013

Officer/Director/Trustee Four

DYLAN EAGLETON
DIRCTOR OF OPERATION
70 BLUEJAY DRIVE
COVINGTON GA 30012

Officer/Director/Trustee Five

DION MCFADDEN
DIRECTOR
900 LEGACY PARK DRIVE
LAWRENCEVILLE GA 30043

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/31/16
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CARLTON MATHIS
Signature Title PRESIDENT
Signature Date 10/19/18

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