FORM 1023-EZ for THE SERENITY CLUB OF SHREVEPORT INC

Field Data
EIN 83-1334580
Case Number EO-2018233-000164
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE SERENITY CLUB OF SHREVEPORT INC
Organization’s Mailing Address 1506 ABBIE ST
City SHREVEPORT
State LA
ZIP 71103
Accounting period End 12
Primary contact name PATRICK MIXON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOROTHY SANDERS
DIRECTOR
3549 E 72ND ST
SHREVEPORT LA 71106

Officer/Director/Trustee Two

WAYNE YOUNG
DIRECTOR
3730 FAIRFIELD AVE -104
SHREVEPORT LA 71104

Officer/Director/Trustee Three

CARNELL FENCEROY
DIRECTOR
9008 CEDAR RIDGE DR
SHREVEPORT LA 71118

Officer/Director/Trustee Four

BRUCE CORNELIOUS
DIRECTOR
3162 SHED RD - 112
SHREVEPORT LA 71111

Officer/Director/Trustee Five

ERICA LOWERY
DIRECTOR
2816 ALKAY DR
SHREVEPORT LA 71118

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/18
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 DOROTHY SANDERS
Signature Title DIRECTOR
Signature Date 8/17/18

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