FORM 1023-EZ for THE COMMUNITY BENCH INC

Field Data
EIN 81-4858792
Case Number EO-2017121-000304
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE COMMUNITY BENCH INC
Organization’s Mailing Address 953 CANTON STREET
City ROSWELL
State GA
ZIP 30075
Accounting period End 12
Primary contact name LORRY KEMP
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORRY KEMP
PRESIDENT
953 CANTON STREET
ROSWELL GA 30075

Officer/Director/Trustee Two

KELLY-SMITH BLACHA
SECRETARY
953 CANTON STREET
ROSWELL GA 30075

Officer/Director/Trustee Three

MICHELLE HOFFSES
TREASURER
20 ARTHURS PLACE
BRIDGEWATER MA 02324

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/19/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code J20 - Employment Procurement Assistance, Job Training
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 Yes
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
Signature Title
Signature Date

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