FORM 1023-EZ for IMPACT MANASSAS INCORPORATED

Field Data
EIN 45-2122639
Case Number EO-2016022-000239
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name IMPACT MANASSAS INCORPORATED
Organization’s Mailing Address 9201 ENTERPRISE COURT
City MANASSAS PARK
State VA
ZIP 20111-4824
Accounting period End 12
Primary contact name JEFFREY A RANDALL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL ROGERS
CEO
8643 MADERA CT
MANASSAS PARK VA 20111-2318

Officer/Director/Trustee Two

MICHELLE ROGERS
SECRETARY
8643 MADERA CT
MANASSAS PARK VA 20111-2318

Officer/Director/Trustee Three

JEFFREY RANDALL
CFO
10458 BRACKETS FORD CIRCLE
MANASSAS VA 20110-2746

Officer/Director/Trustee Four

JOHN ANDERSON
VICE-PRESIDENT
9301 SAFFRON HILL CT
MANASSAS VA 20110-7947

Officer/Director/Trustee Five

DARRYL BURGESS
VICE-PRESIDENT
9142 MINEOLA CT
MANASSAS VA 20111-8261

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2011
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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 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 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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