FORM 1023-EZ for CPAC COMMUNITY FOUNDATION

Field Data
EIN 35-2221576
Case Number EO-2019042-000393
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CPAC COMMUNITY FOUNDATION
Organization’s Mailing Address PO BOX 49023
City COLLEGE PARK
State GA
ZIP 30349-28
Accounting period End 12
Primary contact name JERZELL L BLACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JERZELL BLACK
OFFICER
105 HERITAGE WAY
FAYETTEVILLE GA 30214

Officer/Director/Trustee Two

JOSEPH HARLAND
TRUSTEE
5371 HIGHLAND PINE LANE
MABLETON GA 30126

Officer/Director/Trustee Three

JAMES HODGE
BOARD MEMBER
1111 OAKLEY BLVD APT 6212
FAIRBURN GA 30213

Officer/Director/Trustee Four

CHARLES SUMLIN
BOARD MEMBER
1400 VETERANS MEMORIAL HWY STE 140-
MABLETON GA 30126

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/2/04
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 JERZELL BLACK
Signature Title OFFICER
Signature Date 2/8/19

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