FORM 1023-EZ for LIFE CHANGING OUTREACH CENTER

Field Data
EIN 47-4179517
Case Number EO-2016342-000123
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE CHANGING OUTREACH CENTER
Organization’s Mailing Address 314 SOUTH MAIN STREET
City FAIRMONT
State NC
ZIP 28340-1906
Accounting period End 12
Primary contact name LUIS ROMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHIRLEY SMITH
SECRETARY/TREASURER
594 SILVERSPOON RD
EVERGREEN NC 28438-9644

Officer/Director/Trustee Two

LUIS ROMAN
COO
394 WALTER SHAW RD
EVERGREEN NC 28438-9644

Officer/Director/Trustee Three

JANETTE SMITH
CEO
394 STANLEY CIRCLE
WHITEVILLE NC 28472-4976

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/6/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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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