FORM 1023-EZ for CHANGING LIVES INTERNATIONAL MINISTRIES

Field Data
EIN 20-8127179
Case Number EO-2017313-000473
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHANGING LIVES INTERNATIONAL MINISTRIES
Organization’s Mailing Address 522 ANANMOSA STREET
City RAPID CITY
State SD
ZIP 57701
Accounting period End 12
Primary contact name DEB KOPETSKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HANNA FLEMING
PRESIDENT/TREAS
522 ANANMOSA ST
RAPID CITY SD 57701

Officer/Director/Trustee Two

DEB KOPETSKY
SECRETARY
13378 ALKALI RD
STURGIS SD 57785

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/12/2013
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A12 - Fund Raising and/or Fund Distribution
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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