FORM 1023-EZ for CHANGED 4 LIFE POLK COUNTY
| Field | Data |
|---|---|
| EIN | 81-4336740 |
| Case Number | EO-2018221-000333 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | CHANGED 4 LIFE POLK COUNTY |
| Organization’s Mailing Address | 751 HUTCHINGS MOUNTAIN RD |
| City | ROCKMART |
| State | GA |
| ZIP | 30153 |
| Accounting period End | 12 |
| Primary contact name | SCOTT DEPEW |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
SCOTT DEPEW
CEO
751 HUTCHINGS MTN RD
ROCKMART GA 30153
Officer/Director/Trustee Two
LORI DEPEW
CFO
751 HUTCHINGS MTN RD
ROCKMART GA 30153
Officer/Director/Trustee Three
DENZEL DARDEN
BOARD MEMBER
78 MOUNTAIN VIEW DR
ROCKMARG GA 30153
Officer/Director/Trustee Four
WHITNEY MCCLINIC
SECRETARY
53 RIDGEVIEW DR
SILVER CREEK GA 30173
Officer/Director/Trustee Five
STEVE WOOLFORK
BOARD MEMBER
PEA RIDGE RD
ROCKMART GA 30153
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 11/2/16 |
| Organization Incorporation State | GA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | I21 - Delinquency Prevention |
| Organization’s purpose | Charitable: Yes Religious: Yes 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 | SCOTT DEPEW |
| Signature Title | CEO |
| Signature Date | 8/7/18 |
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