FORM 1023-EZ for IMPACT AGAPE CDC

Field Data
EIN 85-1189239
Case Number EO-2020155-000174
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name IMPACT AGAPE CDC
Organization’s Mailing Address 6525 KRISTINE DR
City FAIRFIELD TOWNSHIP
State OH
ZIP 45011
Accounting period End 12
Primary contact name CORNELIUS HENDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CORNELIUS HENDERSON
CHAIRMAN
6525 KRISTINE DRIVE
FAIRFIELD TOWNSHIP OH 45011

Officer/Director/Trustee Two

MICHELLE HENDERSON
EXECUTIVE DIRECTOR
6525 KRISTINE DRIVE
FAIRFIELD TOWNSHIP OH 45011

Officer/Director/Trustee Three

JOHN COLEMAN
PRESIDENT
3936 DICKSON AVENUE
CINCINNATI OH 45229

Officer/Director/Trustee Four

CRAIG FARLEY
TREASURER
10121 CHESTER ROAD
CINCINNATI OH 45215

Officer/Director/Trustee Five

LANICE WILLIAMS
SECRETARY
536 WADE STREET
CINCINNATI OH 45214

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/27/2020
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: Yes
Public Safety: Yes
Amateur Sports: No
Cruelty Prevention: Yes
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 CORNELIUS HENDERSON
Signature Title CHAIRMAN
Signature Date 6/1/2020

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