FORM 1023-EZ for SPARTAN REHABILITATION SERVICES INC

Field Data
EIN 81-5467493
Case Number EO-2017068-000353
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SPARTAN REHABILITATION SERVICES INC
Organization’s Mailing Address SPARTA DRIVE
City MORROW
State GA
ZIP 30260-2039
Accounting period End 12
Primary contact name LORRETT HIBBERT-SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORRETT HIBBERT-SMITH
CHAIRMAN
2547 SPARTA DRIVE
MORROW GA 30260-2039

Officer/Director/Trustee Two

IRIS CASINO
TREASURER
412 LAKE FRONT COURT
STOCKBRIDGE GA 30281-6291

Officer/Director/Trustee Three

TREVOR SMITH
SECRETARY
144-44 21ST STREET
SPRINGFIELD GARDENS NY 11413-3461

Organization’s website
Organization’s email LORRETTHS54@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/13/2017
Organization Incorporation State GA
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 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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