FORM 1023-EZ for CHAMPIONS CAN FOUNDATION FOR CANCERWELLNESS INC

Field Data
EIN 82-2426272
Case Number EO-2018137-000471
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CHAMPIONS CAN FOUNDATION FOR CANCERWELLNESS INC
Organization’s Mailing Address 3742 GREENWICH AVE
City DULUTH
State GA
ZIP 30096
Accounting period End 12
Primary contact name CRYSTAL CHAMPION
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CRYSTAL CHAMPION
EXEC.DIRECTOR/BOARD CHAIRMAN
3742 GREENWICH AVE
DULUTH GA 30096

Officer/Director/Trustee Two

MARCIA DUPREE
VICE-CHAIRMAN
8480 WEBB ROAD
RIVERDALE GA 30274

Officer/Director/Trustee Three

ADRIENNE JOHNSON
SECRETARY
2780 PADDOCK POINT PLACE
DACULA GA 30019

Officer/Director/Trustee Four

SABRINA WASHINGTON
TREASURER
2200 SATELLITE BLVD APT 809
DULUTH GA 30097

Officer/Director/Trustee Five

ROSALIND WALKER
CO-TREASURER
2704 WANDER LANE
ALPHARETTA GA 30022

Organization’s website N/A
Organization’s email CHAMPIONSCANFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/6/17
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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 CRYSTAL CHAMPION
Signature Title EXEC.DIRECTOR/BOARD CHAIRMAN
Signature Date 5/4/18

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