FORM 1023-EZ for PROVIDENCE ROAD OUTREACH MISSION

Field Data
EIN 83-2892377
Case Number EO-2019030-000180
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PROVIDENCE ROAD OUTREACH MISSION
Organization’s Mailing Address 9525 DONNA DRIVE
City BATON ROUGE
State LA
ZIP 70815
Accounting period End 12
Primary contact name JON ODENWALD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JON ODENWALD
PRESIDENT, DIRECTOR
9525 DONNA DRIVE
BATONROUGE LA 70815

Officer/Director/Trustee Two

BRIAN KINCHEN
TREASURER, DIRECTOR
9525 DONNA DRIVE
BATON ROUGE LA 70815

Officer/Director/Trustee Three

JEFF BRANNON
SECRETARY, DIRECTOR
9525 DONNA DRIVE
BATON ROUGE LA 70815

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/18
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 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 JON ODENWALD
Signature Title PRESIDENT, DIRECTOR
Signature Date 12/21/18

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