FORM 1023-EZ for CHABALA MERCY FOUNDATION INC

Field Data
EIN 46-1324270
Case Number EO-2016193-000582
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHABALA MERCY FOUNDATION INC
Organization’s Mailing Address 1021 DIAMOND WAY
City BOGART
State GA
ZIP 30622
Accounting period End 12
Primary contact name TRUDY JARRARD DIRECTOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TRUDY JARRARD
DIRECTOR
1021 DIAMOND WAY
BOGART GA 30622

Officer/Director/Trustee Two

JIM JARRARD
DIRECTOR
1021 DIAMOND WAY
BOGART GA 30622

Officer/Director/Trustee Three

JANETTE WORLEY
DIRECTOR
1444 WOMACK RD
DUNWOODY GA 30338

Officer/Director/Trustee Four

ANNIE GRACE SMITH
DIRECTOR
1115 MOUNTAIN CREEK CHURCH RD
MONROE GA 30656

Organization’s website NONE
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/11/2012
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P70 - Residential, Custodial Care
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 Yes
Conducting Activities Outside of United States Yes
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
Signature Title
Signature Date

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