FORM 1023-EZ for THE CITY IMPACT

Field Data
EIN 83-0971429
Case Number EO-2018176-000204
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE CITY IMPACT
Organization’s Mailing Address 1785 TAHOE DRIVE
City XENIA
State OH
ZIP 45385
Accounting period End 12
Primary contact name DANIUS WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIUS WILLIAMS
PRESIDENT
1379 BRENTHAVEN PLACE
COLUMBUS OH 43228

Officer/Director/Trustee Two

WHITNEY CAUDILL
VICE PRESIDENT
1785 TAHOE DRIVE
XENIA OH 45385

Officer/Director/Trustee Three

CHRISTOPHER LLOYD KAI VAN DE PITTE
TREASURER
645 OLD HICKORY BLVD UNIT 220
NASHVILLE TN 37209

Organization’s website
Organization’s email THECITYIMPACT@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/18
Organization Incorporation State OH
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: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 DANIUS WILLIAMS
Signature Title PRESIDENT
Signature Date 6/21/18

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