FORM 1023-EZ for ONE HARVEST LIFE CENTER INC

Field Data
EIN 82-2653619
Case Number EO-2021096-001258
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ONE HARVEST LIFE CENTER INC
Organization’s Mailing Address 3661 SUNSET AVENUE SUITE 414
City ROCKY MOUNT
State NC
ZIP 27804
Accounting period End 12
Primary contact name DONIA SIMMONS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DONIA SIMMONS
BOARD CHAIR
101 E CHURCH ST APT 302
TARBORO NC 27886

Officer/Director/Trustee Two

REENA SIMMONS
BOARD MEMBER
100 HUNTER HILL RD APT 15E
TARBORO NC 27886

Officer/Director/Trustee Three

MICHELLE BATTLE
BOARD MEMBER
116 MOYE CT
ROCKY MOUNT NC 27803

Officer/Director/Trustee Four

MAURICE SMITH
BOARD MEMBER
614 TAMMY DRIVE
TARBORO NC 27886

Officer/Director/Trustee Five

PATRICIA PEELE
BOARD MEMBER
107 BROOKSIDE CT
ROANOKE RAPIDS NC 27870

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/30/2017
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 DONIA SIMMONS
Signature Title BOARD CHAIR
Signature Date 3/10/2021

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