FORM 1023-EZ for PASTOR MIKE IMPACT MINISTRIES

Field Data
EIN 85-3942936
Case Number EO-2021022-000188
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PASTOR MIKE IMPACT MINISTRIES
Organization’s Mailing Address 1331 RAINBOW FOREST DR
City TROUVILLE
State VA
ZIP 24175
Accounting period End 12
Primary contact name DAVID MCKELVEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL GROOMS
PRESIDENT
1331 RAINBOW FOREST DR
TROUTVILLE VA 24175

Officer/Director/Trustee Two

JAY LANTZ
SECRETARY-TREASURER
219 BUCKINGHAM CT
ROANOKE VA 24019

Officer/Director/Trustee Three

RICHARD FLOWERS
VICE PRESIDENT
315 KELLER RD
RICON GA 31326

Officer/Director/Trustee Four

NATHAN GROOMS
DIRECTOR
111 HECK STREET
HIGHLAND PARK IL 60035

Officer/Director/Trustee Five

BEVERLY RIGGINS
DIRECTOR
971 OTLEY DRIVE
MECHANICSBURG PA 17055

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/18/2020
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X21 - Protestant
Organization’s purpose Charitable: No
Religious: Yes
Educational: No
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHAEL GROOMS
Signature Title PRESIDENT
Signature Date 11/29/2020

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