FORM 1023-EZ for THE LODGE A COMMUNITY COFFEEHOUSE

Field Data
EIN 83-3019803
Case Number EO-2019031-000231
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE LODGE A COMMUNITY COFFEEHOUSE
Organization’s Mailing Address 4540 MADISON AVENUE
City INDIANAPOLIS
State IN
ZIP 46227-3760
Accounting period End 12
Primary contact name EMILY MITCHELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ADRIENNE HENNING
PRESIDENT
9530 LONGWELL DRIVE
INDIANAPOLIS IN 46240-1197

Officer/Director/Trustee Two

EMILY MITCHELL
SECRETARY
6900 ORINOCO AVENUE
INDIANAPOLIS IN 46227-5049

Officer/Director/Trustee Three

GRACE MITCHELL
TREASURER
5925 SAN MIGUEL CIRCLE
INDIANAPOLIS IN 46250-1226

Officer/Director/Trustee Four

SCOTT MITCHELL
EXECUTIVE DIRECTOR OF OPERATIONS
5832 EMMERT WAY
INDIANAPOLIS IN 46221-3804

Organization’s website HTTP://WWW.THELODGECOFFEE.COM/
Organization’s email INFO@THELODGECOFFEE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/16
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W12 - Fund Raising and/or Fund Distribution
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 EMILY MITCHELL
Signature Title SECRETARY
Signature Date 1/4/19

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