FORM 1023-EZ for CELEBRATE RECOVERY FAIRDALE CORP

Field Data
EIN 87-1813466
Case Number EO-2021210-000042
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CELEBRATE RECOVERY FAIRDALE CORP
Organization’s Mailing Address 9000 BROWN AUSTIN RD
City LOUISVILLE
State KY
ZIP 40118
Accounting period End 12
Primary contact name LARRY MITCHUM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LARRY MITCHUM
PRESIDENT
7601 OSWEGO CIRCLE
LOUISVILLE KY 40214

Officer/Director/Trustee Two

VIVIAN COLLINS
SECRETARY VP OPERATIONS
9000 BROWN AUSTIN RD
FAIRDALE KY 40118

Officer/Director/Trustee Three

JAIME SCHNELL
TREASURER
9000 BROWN AUSTIN RD
FAIRDALE KY 40118

Officer/Director/Trustee Four

RUDOLPH MACHACEK
VP SPECIAL EVENTS
9000 BROWN AUSTIN RD
LOUISVILE KY 40118

Officer/Director/Trustee Five

ANTHONY DAVIS
CHIEF COMPLIANCE OFFICER
9905 BLUE LICK RD
LOUISVILLE KY 40229

Organization’s website
Organization’s email L.MITCHUM@TWC.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/22/2021
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 LARRY MITCHUM
Signature Title PRESIDENT
Signature Date 7/26/2021

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