FORM 1023-EZ for FAMILY COMMUNITY CASE MANAGEMENT

Field Data
EIN 84-3932884
Case Number EO-2019351-000065
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY COMMUNITY CASE MANAGEMENT
Organization’s Mailing Address 4513 NORMANDY LANE
City FORT WORTH
State TX
ZIP 76103
Accounting period End 12
Primary contact name LANG ELLIOTT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LANG ELLIOTT
PRESIDENT
4513 NORMANDY LANE
FORT WORTH TX 76103

Officer/Director/Trustee Two

LAJOYA STEVENSON
SECRETARY
4513 NORMANDY LANE
FORT WORTH TX 76103

Officer/Director/Trustee Three

KALEA ELLIOTT
TREASURER
4513 NORMANDY LANE
FORT WORTH TX 76103

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/9/2019
Organization Incorporation State TX
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: Yes
Religious: No
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 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 LANG ELLIOTT
Signature Title PRESIDENT
Signature Date 12/13/2019

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