FORM 1023-EZ for SOUTH HOLD COMMUNITY REVITALIZATIONCORPORATION

Field Data
EIN 81-2014128
Case Number EO-2016092-000369
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTH HOLD COMMUNITY REVITALIZATIONCORPORATION
Organization’s Mailing Address 1821 LEER STREET
City SOUTH BEND
State IN
ZIP 46613-3024
Accounting period End 3
Primary contact name DAVID A SHELLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID SHELLEY
EXECUTIVE DIRECTOR, PRESIDENT
1821 LEER STREET
SOUTH BEND IN 46613-3024

Officer/Director/Trustee Two

JAMILLA KHAMA
DIRECTOR, VICE PRESIDENT
1512 LEER STREET
SOUTH BEND IN 46613-3019

Officer/Director/Trustee Three

ROME JOHNSON
DIRECTOR, TREASURER
921 EAST DONALD STREET
SOUTH BEND IN 46613-2920

Officer/Director/Trustee Four

NOVA KELLNER
DIRECTOR, SECRETARY
16055 BRANCHWOOD LANE
GRANGER IN 46530-7036

Organization’s website WWW.SOUTHHOLD.COM
Organization’s email SOUTHHOLDCRC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/22/2016
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P28 - Neighborhood Centers, Settlement Houses
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 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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