FORM 1023-EZ for CENTER FOR CHANGE AND COMMUNITY LIFE INC

Field Data
EIN 47-5284301
Case Number EO-2015286-000272
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CENTER FOR CHANGE AND COMMUNITY LIFE INC
Organization’s Mailing Address 5010 RAINBOW HILLS RD
City JEFFERSON CITY
State MO
ZIP 65109-0273
Accounting period End 6
Primary contact name ADRION HENDRICKS II
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ADRION HENDRICKS II
DIRECTOR
5010 RAINBOW HIILS RD
JEFFERSON CITY MO 65109-0273

Officer/Director/Trustee Two

ANDRIA HENDRICKS
DIRECTOR
5010 RAINBOW HILLS RD
JEFFERSON CITY MO 65109-0273

Officer/Director/Trustee Three

CALLIE NEWSOM
DIRECTOR
800 LOCUST ST SHERMAN HALL 107
JEFFERSON CITY MO 65101-3535

Officer/Director/Trustee Four

AANISAH WATSON
DIRECTOR
3927 VICKIE DR
JEFFERSON CITY MO 65109-9367

Organization’s website
Organization’s email CENTER4CCL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/9/2015
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S50 - Nonprofit Management
Organization’s purpose Charitable: Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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