FORM 1023-EZ for IN HIS IMAGE YOUTH SPORTS AND MENTORING

Field Data
EIN 82-4940144
Case Number EO-2018165-000695
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name IN HIS IMAGE YOUTH SPORTS AND MENTORING
Organization’s Mailing Address 3454 MONTICELLO BLVD
City CLEVELAND
State OH
ZIP 44121
Accounting period End 3
Primary contact name DERRON POTTS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DERRON POTTS
PRESIDENT
3454 MONTICELLO BLVD
CLEVELAND OH 44121

Officer/Director/Trustee Two

MARCUS LOWE
VICE PRESIDENT
3715 WARRENSVILLE CENTER RD APT 512
CLEVELAND OH 44122

Officer/Director/Trustee Three

CHRIS SUSTER
TREASURER
2201 REXWOOD RD UP
CLEVELAND OH 44118

Officer/Director/Trustee Four

AUSTIN BENAMON
SECRETARY
1514 SHERIDAN RD NE 4203
ATLANTA GA 30324

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/28/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W70 - Leadership Development
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 DERRON POTTS
Signature Title PRESIDENT
Signature Date 6/12/18

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