FORM 1023-EZ for TEAM CARE OUTREACH SERVICES INC

Field Data
EIN 47-5549718
Case Number EO-2016048-000211
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TEAM CARE OUTREACH SERVICES INC
Organization’s Mailing Address 2180 DULUTH HWY STE 400
City DULUTH
State GA
ZIP 30097
Accounting period End 12
Primary contact name STACY BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

STACY BROWN
PRESIDENT, DIRECTOR
2579 TULLAMORE CIR
SNELLVILLE GA 30039

Officer/Director/Trustee Two

JENNIFER SMITH
SECRETARY, DIRECTOR
161 CANTERBURY LN
LAWRENCEVILLE GA 30046

Officer/Director/Trustee Three

LENEIVA HEAD
TREASURER, DIRECTOR
628 APPLEJACK CT
CANE RIDGE TN 37013

Officer/Director/Trustee Four

CARRIE CLAYBROOK
VICE PRESIDENT, DIRECTOR
1717 WILLOUGHBY DR
BUFORD GA 30519

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/10/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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
Signature Title
Signature Date

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