FORM 1023-EZ for CHAMPION AUTISM NETWORK
| Field | Data |
|---|---|
| EIN | 81-1376843 |
| Case Number | EO-2016097-000143 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | CHAMPION AUTISM NETWORK |
| Organization’s Mailing Address | 1413 HWY 17 S PMB 148 |
| City | SURFSIDE BEACH |
| State | SC |
| ZIP | 29575 |
| Accounting period End | 12 |
| Primary contact name | BECKY LARGE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $400.00 |
Officer/Director/Trustee One
BECKY LARGE
EXECUTIVE DIRECTOR
13 S MYRTLE DR
SURFSIDE BEACH SC 29575
Officer/Director/Trustee Two
MICHAEL LARGE
DIRECTOR
13 S MYRTLE DR
SURFSIDE BEACH SC 29575
Officer/Director/Trustee Three
RICHARD SEXTON
DIRECTOR
1265 BRAEBURN RD NW
CONCORD NC 28027
Officer/Director/Trustee Four
SAMMY TRUETT
DIRECTOR
520 14TH AVE N
SURFSIDE BEACH SC 29575
Officer/Director/Trustee Five
MICHELE DIVETERANO
DIRECTOR
1433 S CLARION ST
PHILADELPHIA PA 10147
| Organization’s website | WWW.CHAMPIONAUTISMNETWORK.COM |
|---|---|
| Organization’s email | CHAMPIONAUTISMNETWORK@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 2/12/2016 |
| Organization Incorporation State | SC |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | G84 - Autism |
| 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 | |
| Signature Title | |
| Signature Date |
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