FORM 1023-EZ for EMPOWER INDY INC

Field Data
EIN 30-0935684
Case Number EO-2017096-000228
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMPOWER INDY INC
Organization’s Mailing Address 4110 E NEW YORK ST
City INDIANAPOLIS
State IN
ZIP 46201
Accounting period End 6
Primary contact name DERRICK HOWELL MCQUEEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DERRICK HOWELL MCQUEEN
PRESIDENT
1201 INDIANA AVE APT 1608
INDIANAPOLIS IN 46202

Officer/Director/Trustee Two

DOMINICIA COLLINS
VICE PRESIDENT
231 N ORIENTAL ST
INDIANAPOLIS IN 46202

Officer/Director/Trustee Three

CORDIA WATKINS
SECRETARY
4272 DEVON DR
INDIANAPOLIS IN 46226

Organization’s website
Organization’s email D,HOWELLMCQUEEN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/17/2017
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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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