FORM 1023-EZ for EMPOWERING SURVIVORS SUCCESS

Field Data
EIN 84-4032500
Case Number EO-2020021-000294
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EMPOWERING SURVIVORS SUCCESS
Organization’s Mailing Address 950 EAGLES LANDING PKWY UNIT 881
City STOCKBRIDGE
State GA
ZIP 30281-7343
Accounting period End 12
Primary contact name TONYA EDMONDS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TYLER GOINS
DIRECTOR
477 WILMER ST NE UNIT 2514
ATLANTA GA 30308-3021

Officer/Director/Trustee Two

AUBREY THOMAS
DIRECTOR
3211 MARBLEHEAD COVE NE
CONYERS GA 30012-2667

Officer/Director/Trustee Three

AMY LIND
DIRECTOR
215 RIPPLING DR NW
MARIETTA GA 30064-5033

Officer/Director/Trustee Four

TONYA EDMONDS
TRUSTEE
950 EAGLES LANDING PKWY UNIT 881
STOCKBRIGE GA 30281-7343

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/9/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F32 - Community Mental Health Center
Organization’s purpose Charitable: Yes
Religious: No
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 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 TONYA EDMONDS
Signature Title TRUSTEE
Signature Date 1/16/2020

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