FORM 1023-EZ for A CHANCE FOR CHAMP

Field Data
EIN 82-4383911
Case Number EO-2018054-000130
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A CHANCE FOR CHAMP
Organization’s Mailing Address 711 REAGAN SPRINGS ROAD
City SEYMOUR
State TN
ZIP 37865
Accounting period End 12
Primary contact name MICHELLE WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSICA MONTGOMERY
VICE PRESIDENT
11730 E BALBOA PLACE
TUCSON AZ 85749

Officer/Director/Trustee Two

SHARON BELL
PRESIDENT
8832 FOX LONAS ROAD
KNOXVILLE TN 37923

Officer/Director/Trustee Three

DOUG WITMER
TREASURER
1405 HIDDEN HILLS DRIVE
CLINTON TN 37716

Officer/Director/Trustee Four

MICHELLE WHITE
DIRECTOR
711 REAGAN SPRINGS ROAD
SEYMOUR TN 37865

Officer/Director/Trustee Five

KEVIN WHITE
ASSISTANT DIRECTOR
711 REAGAN SPRINGS ROAD
SEYMOUR TN 37865

Organization’s website
Organization’s email ACHANCEFORCHAMP@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/18
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHELLE WHITE
Signature Title DIRECTOR
Signature Date 2/21/18

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