FORM 1023-EZ for FIVE STAR EMPOWERMENT FOUNDATION

Field Data
EIN 81-1518461
Case Number EO-2016055-000250
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FIVE STAR EMPOWERMENT FOUNDATION
Organization’s Mailing Address 1517 AMBERLEY WOODS CIR
City HELENA
State AL
ZIP 35080
Accounting period End 12
Primary contact name EREK YARBROUGH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EREK YARBROUGH
PRESIDENT
1517 AMBERLEY WOODS CIR
HELENA AL 35080

Officer/Director/Trustee Two

DARRELL PETTIE
SECRETARY
2731 HOLBROOK AVE
BESSEMER AL 35020

Officer/Director/Trustee Three

LOUIS JONES
TREASURE
6496 ASPEN LANE
HUEYTOWN AL 35023

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/19/2016
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
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 Yes
One Third Support Gifts No
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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