FORM 1023-EZ for ADULT FIVE INC

Field Data
EIN 47-2569974
Case Number EO-2015096-000177
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ADULT FIVE INC
Organization’s Mailing Address 13935 HWY 84 WEST
City NEWTON
State AL
ZIP 36352
Accounting period End 12
Primary contact name GLENDA COLEMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOSEPH FLOYD
PRESIDENT
896 VINSON ROAD
SLOCOMB AL 36375-5076

Officer/Director/Trustee Two

CAROLYN HICKS
VICE PRESIDENT
13935 HWY 84 W
NEWTON AL 36352

Officer/Director/Trustee Three

CHERYL TODD
SECRETARY
400 FORSYTHIA LANE
DOTHAN AL 36305-5837

Officer/Director/Trustee Four

LARRY HICKS
DIRECTOR
13935 HWY 84 W
NEWTON AL 36352

Officer/Director/Trustee Five

GLENDA COLEMAN
DIRECTOR
104 KRAMER CT
DOTHAN AL 36305-3105

Organization’s website N/A
Organization’s email GRCCADINC@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/2/2015
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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
Signature Title
Signature Date

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