FORM 1023-EZ for PROVIDENCE OAK INC

Field Data
EIN 83-3484425
Case Number EO-2020079-000117
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PROVIDENCE OAK INC
Organization’s Mailing Address 4486 GA HWY 86
City SOPERTON
State GA
ZIP 30457
Accounting period End 12
Primary contact name KIMBERLY ELY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KIMBERLY ELY
REGISTERED AGENT
4486 GA HWY 86
SOPERTON GA 30457

Officer/Director/Trustee Two

TABITHA RING
SECRETARY
573 MEEKS RD
ADRIAN GA 31002

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/2019
Organization Incorporation State GA
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 Yes
Donation of funds Yes
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 KIMBERLY ELY
Signature Title REGISTERED AGENT
Signature Date 3/17/2020

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