FORM 1023-EZ for FOUNTAIN CITY SLAM INC

Field Data
EIN 83-2941585
Case Number EO-2019176-000197
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOUNTAIN CITY SLAM INC
Organization’s Mailing Address 1258 CEDAR AVENUE UNIT 301
City COLUMBUS
State GA
ZIP 31906
Accounting period End 12
Primary contact name JONATHAN S PERKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JONATHAN PERKINS
CEO
1258 CEDAR AVENUE UNIT 301
COLUMBUS GA 31906

Officer/Director/Trustee Two

CRYSTAL PENDLETON SHAHID
PRESIDENT
1024 KING PLACE DRIVE
COLUMBUS GA 31904

Officer/Director/Trustee Three

KIMBERLY MITCHELL
VICE PRESIDENT
6325 MILGEN ROAD UNIT 2
COLUMBUS GA 31907-9714

Officer/Director/Trustee Four

RAVEN HENDERSON
SECRETARY
2927 MIMOSA STREET
COLUMBUS GA 31906

Officer/Director/Trustee Five

PAULA CRAWFORD CORRICK
TREASURER
3615 DENEWOOD COURT
COLUMBUS GA 31909

Organization’s website FOUNTAINCITYSLAM.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/2/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A90 - Arts Service Organizations and Activities
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 JONATHAN PERKINS
Signature Title CEO
Signature Date 6/20/19

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