FORM 1023-EZ for IMPACT LIVES INC

Field Data
EIN 81-4744227
Case Number EO-2017037-000307
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name IMPACT LIVES INC
Organization’s Mailing Address PO BOX 11462
City BALTIMORE
State MD
ZIP 21239
Accounting period End 12
Primary contact name MICHAEL WESTBROOK JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL WESTBROOK JR
PRESIDENT
PO BOX 11462
BALTIMORE MD 21239

Officer/Director/Trustee Two

RAQUEL WESTBROOK
SECRETARY
PO BOX 11462
BALTIMORE MD 21239

Officer/Director/Trustee Three

ROBERT DENNIS
TREASURER
PO BOX 1791
OWINGS MILLS MD 21117

Organization’s website
Organization’s email IMPACLIVES@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/20/2016
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
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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