FORM 1023-EZ for POSITIVE LIFE ATHLETIC YOUTH

Field Data
EIN 82-3694743
Case Number EO-2018037-000091
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POSITIVE LIFE ATHLETIC YOUTH
Organization’s Mailing Address 21200 E 4TH ST S
City INDEPENDENCE
State MO
ZIP 64056
Accounting period End 8
Primary contact name JOHN CAMPBELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN CAMPBELL
PRESIDENT
21200 E 4TH ST S
INDEPDENCE MO 64056

Officer/Director/Trustee Two

CONNIE GRIFFITH-GIVENS
VICE PRESIDENT
11105 E SCARRITT AVE
SUGAR CREEK MO 64054

Officer/Director/Trustee Three

PAMELA OKANE
TREASURER
3239 E 28TH ST
KANSAS CITY MO 64128

Officer/Director/Trustee Four

ANGELA HARMON
SECRETARY
6730 JAMES A REED RD
RAYTOWN MO 64133

Organization’s website
Organization’s email POSITIVE.LIFE.ATHLETIC.YOUTH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/5/17
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
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 Yes
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 JOHN CAMPBELL
Signature Title PRESIDENT
Signature Date 2/2/18

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