FORM 1023-EZ for OPERATION IMPACT 22

Field Data
EIN 84-3234789
Case Number EO-2019277-000886
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OPERATION IMPACT 22
Organization’s Mailing Address 7933 COOLIDGE ST
City NORWALK
State IA
ZIP 50211
Accounting period End 12
Primary contact name CLAYTON GARCIA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CLAYTON GARCIA
PRESIDENT
7933 COOLIDGE ST
NORWALK IA 50211

Officer/Director/Trustee Two

RACHEL GARCIA
MEMBER
7933 COOLIDGE ST
NORWALK IA 50211

Officer/Director/Trustee Three

TIMOTHY MCCARLEY
MEMBER
116 SELWYN DR
ANDERSON SC 29625

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/19
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention N.E.C.
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 CLAYTON GARCIA
Signature Title PRESIDENT
Signature Date 10/2/19

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