FORM 1023-EZ for ASSURED AND ASSOCIATES FOUNDATION INC

Field Data
EIN 47-5232317
Case Number EO-2015292-000220
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ASSURED AND ASSOCIATES FOUNDATION INC
Organization’s Mailing Address 8336 OFFICE PARK DR
City DOUGLASVILLE
State GA
ZIP 30134
Accounting period End 12
Primary contact name LAVERNE REEVES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RUBY BROWN
BOARD PRESIDENT
8687 HOSPITAL DR
DOUGLASVILLE GA 30134

Officer/Director/Trustee Two

DENNIS CONNALLY
SECRETARY
8336 OFFICE PARK DR
DOUGLASVILLE GA 30134

Officer/Director/Trustee Three

ALLEN SHACTMAN
TREASURER
8336 OFFICE PARK DR
DOUGLASVILLE GA 30134

Officer/Director/Trustee Four

SHELLEY WILLIAMS
BOARD MEMBER
8336 OFFICE PARK DR
DOUGLASVILLE GA 30134

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/21/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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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