FORM 1023-EZ for POTTERS HOUSE HOMES FOR CHILDREN INC

Field Data
EIN 58-2550099
Case Number EO-2016272-000208
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name POTTERS HOUSE HOMES FOR CHILDREN INC
Organization’s Mailing Address 5183 LEGENDS DR
City BRASELTON
State GA
ZIP 30517-6210
Accounting period End 12
Primary contact name JEFFREY TOBIAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFFREY TOBIAS
EXECUTIVE DIRECTOR-BOARD
5183 LEGENDS DR
BRASELTON GA 30517-6210

Officer/Director/Trustee Two

VIVIAN TOBIAS
PROGRAM DIRECTOR-BOARD
5183 LEGEND DR
BRASELTON GA 30517-6210

Officer/Director/Trustee Three

DOROTHY HARRIS
BOARD MEMBER
1120 BRADFORD PARK
AUBURN GA 30011

Officer/Director/Trustee Four

ANN THOMAS
BOARD MEMBER
30 BUNKER LABE
CONYERS GA 30013

Officer/Director/Trustee Five

SHEILA WILLIAMS
BOARD MEMBER
753 WOODSTONE
LITHONIA GA 30058

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2000
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F33 - Group Home, Residential Treatment Facility - Mental Health Related
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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