FORM 1023-EZ for LIFE IMPACT CONNECTIONS INC

Field Data
EIN 81-2565378
Case Number EO-2016161-000336
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE IMPACT CONNECTIONS INC
Organization’s Mailing Address 6503 LONGOAK CT
City LAKELAND
State FL
ZIP 33811-3108
Accounting period End 12
Primary contact name REV KENT ADRIAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVE ROCKNESS
DIRECTOR
824 MICHIGAN ST
MOUNT DORA FL 32757-6077

Officer/Director/Trustee Two

CHARLES GERMAN
DIRECTOR
20909 CEMETARY RD
PRINCEVILLE IL 61559-9765

Officer/Director/Trustee Three

SPRING VESPER
DIRECTOR
4305 MELBROOKE CT
LAKELAND FL 33811-3205

Officer/Director/Trustee Four

KENT ADRIAN
PRESIDENT
6503 LONGOAK CT
LAKELAND FL 33811-3108

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/25/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
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 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
Signature Title
Signature Date

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