FORM 1023-EZ for ACADEMICALLY EMPOWERED INC

Field Data
EIN 47-3107680
Case Number EO-2015065-000318
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ACADEMICALLY EMPOWERED INC
Organization’s Mailing Address 1399 THOMPSON BRIDGE ROAD
City GAINESVILLE
State GA
ZIP 30501-1709
Accounting period End 12
Primary contact name AVA WHITE OR ELAINE NIEDERQUELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RICHARD MALCOLM
CHAIRMAN
399 SANTA PERA DRIVE
CLEVELAND GA 30528-4364

Officer/Director/Trustee Two

KEVIN THARPE
DIRECTOR
5344 HILLSHIRE COURT
FLOWERY BRANCH GA 30542-2584

Officer/Director/Trustee Three

LINDA NILES
DIRECTOR
5664 RANSOM FREE ROAD
CLERMONT GA 30527-2042

Officer/Director/Trustee Four

MARSHA TUCKER
DIRECTOR
4732 UPPER BERKSHIRE ROAD
FLOWERY BRANCH GA 30542-3690

Officer/Director/Trustee Five

NANCY HAVLIK
DIRECTOR
925 PARK HILL DRIVE
GAINESVILLE GA 30501-2337

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/2/2015
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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