FORM 1023-EZ for IMPACT ONE INTERNATIONAL MINISTRIESINCORPORATED

Field Data
EIN 90-1016557
Case Number EO-2016060-000349
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name IMPACT ONE INTERNATIONAL MINISTRIESINCORPORATED
Organization’s Mailing Address 931 WEST CLEVELAND AVE
City ELKHART
State IN
ZIP 46516
Accounting period End 12
Primary contact name DIRECTOR KELLIE HENNINGS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KELLIE HENNINGS
PRESIDENT
931 WEST CLEVELAND AVE
ELKHART IN 46516

Officer/Director/Trustee Two

JNARA DAVIS
TREASURER
931 WEST CLEVELAND AVE
ELKHART IN 46516

Officer/Director/Trustee Three

JNARA DAVIS
SECRETARY
931 WEST CLEVELAND AVE
ELKHART IN 46516

Officer/Director/Trustee Four

KELLIE HHENNINGS
SECRETARY
931 WEST CLEVELAND AVE
ELKHART IN 46516

Officer/Director/Trustee Five

PROPHETESS KELLIE HENNINGS
CEO
931 WEST CLEVELAND AVE
ELKHART IN 46516

Organization’s website
Organization’s email MS.ENTHUSIASUM@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/26/2016
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: No
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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