FORM 1023-EZ for LIFE SUPPORT COALITION

Field Data
EIN 81-0811918
Case Number EO-2016020-000040
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE SUPPORT COALITION
Organization’s Mailing Address 245 GILLICAN CIRCLE
City HOMERVILLE
State GA
ZIP 31634
Accounting period End 12
Primary contact name GLENN D KING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GLYNN D KING
PRESIDENT
245 GILLICAN CIRCLE
HOMERVILLE GA 31634

Officer/Director/Trustee Two

BYRON D KING
DIRECTOR
1010 TOOMBS ST APT 4
VALDOSTA GA 31601

Officer/Director/Trustee Three

JOHNNY JAMES
DIRECTOR
610 11TH COURT SE
MOULTRIE GA 31768

Officer/Director/Trustee Four

RAFEAL D KING
DIRECTOR
495 BIG BEAR BLVD
MOULTRIE GA 31768

Officer/Director/Trustee Five

ALLEN F CHARITY
D
530B 8TH AVE SE
MOULTIRE GA 31768

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/15/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
Literary: Yes
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
Signature Title
Signature Date

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