FORM 1023-EZ for MENTORING VILLAGE INC

Field Data
EIN 82-4716297
Case Number EO-2018071-000321
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MENTORING VILLAGE INC
Organization’s Mailing Address 200 NORTHSIDE DRIVE
City CARROLLTON
State GA
ZIP 30117
Accounting period End 12
Primary contact name CATHY ROBINSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KENNY EDWARDS
BOARD PRESIDENT
406 SHADY VALLEY DRIVE
CARROLLTON GA 30116

Officer/Director/Trustee Two

MANDY BAUEMEL
BOARD MEMBER
ONE SOUTHWIRE DRIVE
CARROLLTON GA 30117

Officer/Director/Trustee Three

FAITH WRIGHT
SECRETARY
21 CABLE INDUSTRIAL BOULEVARD
CARROLLTON GA 30117

Officer/Director/Trustee Four

GRACE PIPPIN
BOARD MEMBER
110 DIXIE STREET
CARROLLTON GA 30117

Officer/Director/Trustee Five

LEILA SHAVER
TREASURER
500 OLD BREMEN ROAD SUITE 101
CARROLLTON GA 30117

Organization’s website WWW.MENTORINGVILLAGE.ORG
Organization’s email CATHY.R@MENTORINGVILLAGE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: Yes
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 LEILA SHAVER
Signature Title TREASURER
Signature Date 3/9/18

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