FORM 1023-EZ for STRUCTURED CHANGE INITIATIVE

Field Data
EIN 81-0903584
Case Number EO-2017067-000701
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STRUCTURED CHANGE INITIATIVE
Organization’s Mailing Address PO BOX 3725
City SOUTHFIELD
State MI
ZIP 48037-3725
Accounting period End 12
Primary contact name ERICA M KELLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERICA KELLEY
PRESIDENT
23955 ROCKINGHAM
SOUTHFIELD MI 48037-3725

Officer/Director/Trustee Two

DAMON THOMPSON
DIRECTOR
11401 PLAINVIEW
DETROIT MI 48228-1380

Officer/Director/Trustee Three

ENNA BACHELOR
DIRECTOR
18582 WOODSIDE
HARPER WOODS MI 48228-2122

Organization’s website
Organization’s email SCINITIATIVE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/23/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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 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
Signature Title
Signature Date

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