FORM 1023-EZ for ALTERED LIVES RECOVERY SERVICES INC

Field Data
EIN 82-2844336
Case Number EO-2019170-000235
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ALTERED LIVES RECOVERY SERVICES INC
Organization’s Mailing Address 335 BREADEN ST
City YOUNGSTOWN
State OH
ZIP 44502
Accounting period End 12
Primary contact name ROBINETTE CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBINETTE CLARK
PRESIDENT
335 BREADEN ST
YOUNGSTOWN OH 44502

Officer/Director/Trustee Two

SHALAINE ENAHORA
BOARD MEMBER
4807 S LAWERENCE ST
CHICAGO IL 60615

Officer/Director/Trustee Three

IRISH FINN
BOARD MEMBER
2153 YOUNGSTOWN RD
YOUNGSTOWN OH 44484

Officer/Director/Trustee Four

CAROL HENDERSON
BOARD MEMBER
3194 DEAR TRAIL
CORTLAND OH 44410

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/2/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ROBINETTE CLARK
Signature Title PRESIDENT
Signature Date 6/17/19

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