FORM 1023-EZ for JOHNS CREEK ROTARY FOUNDATION INC

Field Data
EIN 81-2408472
Case Number EO-2016161-000293
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JOHNS CREEK ROTARY FOUNDATION INC
Organization’s Mailing Address 6910 MCGINNIS FERRY RD
City ALPHARETTA
State GA
ZIP 30005
Accounting period End 12
Primary contact name SUSAN T GRISSOM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL MCCULLAR
PRESIDENT AND CEO
6910 MCGINNIS FERRY RD
ALPHARETTA GA 30005

Officer/Director/Trustee Two

ROBERT OSTAPOWER
TREASURER AND CFO
5640 MILLWICK DRIVE
ALPHARETTA GA 30005

Officer/Director/Trustee Three

MARC LITT
SECRETARY
12519 DARVISH LANE
ALPHARETTA GA 30005

Officer/Director/Trustee Four

RENDER FREEMAN
TRUSTEE
6165 MILLWICK DRIVE
JOHNS CREEK GA 30005

Officer/Director/Trustee Five

LUCK HAYMOND
TRUSTEE
10285 WORTHINGTON MANOR
SUWANEE GA 30024

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/11/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
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 Yes
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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