FORM 1023-EZ for VITALITY VILLAGE INC

Field Data
EIN 83-2712086
Case Number EO-2018341-000472
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name VITALITY VILLAGE INC
Organization’s Mailing Address 1606 GREENBROOK DRIVE
City AUSTELL
State GA
ZIP 30168
Accounting period End 12
Primary contact name SHUNDRIKA WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHUNDRIKA WILLIAMS
EXECUTIVE DIRECTOR
1606 GREENBROOK DRIVE
AUSTELL GA 30168

Officer/Director/Trustee Two

NALANI COBB
SECRETARY
1530 JUSTINE WAY SE
MABLETON GA 30126

Officer/Director/Trustee Three

BIANCA HARRELL
TREASURER
1591 PARK BROOKE CIRCLE
MARIETTA GA 30008

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/13/18
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: 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 SHUNDRIKA WILLIAMS
Signature Title EXECUTIVE DIRECTOR
Signature Date 12/5/18

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