FORM 1023-EZ for IMPACT

Field Data
EIN 46-1151249
Case Number EO-2021210-000037
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name IMPACT
Organization’s Mailing Address 1443 EAST 69TH STREET
City CHICAGO
State IL
ZIP 60637
Accounting period End 12
Primary contact name ANDRE W RAWLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDRE RAWLS
CHIEF EXECUITVE OFFICER
7321 S SOUTH SHORE DR APT 1C
CHICAGO IL 60649

Officer/Director/Trustee Two

SHAKA RAWLS
FOUNDER EXC DIRECTOR
1443 EAST 69TH STREET
CHICAGO IL 60637

Officer/Director/Trustee Three

KEISHA KDAN
SECRETARY
7321 S SOUTH SHORE DR APT 2B
CHICAGO IL 60649-3566

Organization’s website IMPACTINGCHANGE.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/15/2012
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 Yes
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 Yes
Correctness Declaration Yes
Signature Name ANDRE RAWLS
Signature Title CHIEF EXECUITVE OFFICER
Signature Date 7/26/2021

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