FORM 1023-EZ for LIVING TO LIVE AGAIN MINISTRIES JACOBS WELL

Field Data
EIN 20-4179756
Case Number EO-2016300-000370
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIVING TO LIVE AGAIN MINISTRIES JACOBS WELL
Organization’s Mailing Address 5940 WATCH CHAIN WAY
City COLUMBIA
State MD
ZIP 21044
Accounting period End 12
Primary contact name ALFREDA ADAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALFREDA ADAMS
BOARD CHAIR
5940 WATCH CHAIN WAY
COLUMBIA MD 21044

Officer/Director/Trustee Two

DANIEL MEJIAS
VICE CHAIR
626 ANTRIM ROAD
XENIA OH 45385

Officer/Director/Trustee Three

DENISE HINES
TREASURER
6668 ASPERN DRIVE
ELKRIDGE MD 21075

Officer/Director/Trustee Four

CAROLYN WATSON
SECRETARY
3716 SEQUOIA AVENUE
BALTIMORE MD 21215

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/14/2014
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 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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