FORM 1023-EZ for ADDICTION RECOVERY REVOLUTION

Field Data
EIN 47-3680666
Case Number EO-2015112-000161
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ADDICTION RECOVERY REVOLUTION
Organization’s Mailing Address PO BOX 252
City MANSFIELD
State PA
ZIP 16933
Accounting period End 12
Primary contact name PAMELA JENKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PAMELA JENKINS
PRESIDENT
74 JENKINS LANE
MANSFIELD PA 16933

Officer/Director/Trustee Two

JOYCE NICHOLS
TREASURER
1464 E LAWRENCE RD
LAWRENCEVILLE PA 16929

Officer/Director/Trustee Three

TIFFANY WELCH
VICE PRESIDENT
PO BOX 43
TIOGA PA 16946

Officer/Director/Trustee Four

DIANNA TOWNSEND
SECRETARY
11064 RT 287
MIDDLEBURY CENTER PA 16935

Officer/Director/Trustee Five

KAREN CARLIN
BOARD OF DIRECTOR
3720 CUMMINGS CREEK RD
LAWRENCEVILLE PA 16929

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/13/2013
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
Organization’s purpose Charitable: Yes
Religious: No
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 Yes
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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