FORM 1023-EZ for ENDEAVOR ADAPTIVE SPORTS INC

Field Data
EIN 82-1965744
Case Number EO-2017202-000231
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ENDEAVOR ADAPTIVE SPORTS INC
Organization’s Mailing Address 6620 CEDAR MILL COURT
City ACWORTH
State GA
ZIP 30102
Accounting period End 12
Primary contact name REBECCA JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REBECCA JOHNSON
PRESIDENT
6620 CEDAR MILL COURT
ACWORTH GA 30102

Officer/Director/Trustee Two

DEBORAH WALLER
VICE PRESIDENT
700 SHANNON DRIVE
MARIETTA GA 30066

Officer/Director/Trustee Three

RAQUEL GAVINA
SECRETARY
415 KATHERINE LANE
WOODSTOCK GA 30189

Officer/Director/Trustee Four

DEANA BOHANNON
TREASURER
1454 RIVERBEND ROAD SW
PLAINVILLE GA 30733

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/23/2017
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 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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