FORM 1023-EZ for URBAN SCUBA KIDS

Field Data
EIN 82-2511852
Case Number EO-2021140-000442
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name URBAN SCUBA KIDS
Organization’s Mailing Address 2050 SURREY TRL
City ATLANTA
State GA
ZIP 30349
Accounting period End 8
Primary contact name TODD C CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TODD CLARK
DIRECTOR
2050 SURREY TRL
ATLANTA GA 30349

Organization’s website URBANSCUBAKIDS.ORG
Organization’s email TCLARK@URBANSCUBAKIDS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/28/2017
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: No
Religious: No
Educational: Yes
Scientific: Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TODD CLARK
Signature Title DIRECTOR
Signature Date 5/13/2021
EIN 82-2511852
Case Number EO-2018140-000099
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name URBAN SCUBA KIDS
Organization’s Mailing Address 2221 PEACHTREE RD NE STE D-464
City ATLANTA
State GA
ZIP 30309
Accounting period End 10
Primary contact name TODD CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TODD CLARK
CEO
301 MEMORIAL DRIVE SOUTHEAST 114
ATLANTA GA 30312

Officer/Director/Trustee Two

LIZA HARE
CFO
418 REGISTRY BLUFF
STONE MOUNTIAN GA 30087

Officer/Director/Trustee Three

VINCENT BAKER
COO
3127 HAROLD DEAN DR
MARIETTA GA 30066

Organization’s website WWW.URBANSCUBAKIDS.ORG
Organization’s email TCLARK@URBANSCUBAKIDS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/30/17
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: No
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 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 TODD CLARK
Signature Title CEO
Signature Date 5/15/18

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