FORM 1023-EZ for MEDIA MENTOR INC

Field Data
EIN 84-3487293
Case Number EO-2019301-000716
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MEDIA MENTOR INC
Organization’s Mailing Address 156 STRAWBERRY PLAINS RD STE C1
City WILLIAMSBURG
State VA
ZIP 23188
Accounting period End 12
Primary contact name BRIAN J SMALLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN SMALLS
DIRECTOR
216 STRAWBERRY PLAINS RD
WILLIAMSBURG VA 23188

Officer/Director/Trustee Two

RANDALL HAZARD
DIRECTOR
8929 FARYS MILL ROAD
GLOUCESTER VA 23061

Officer/Director/Trustee Three

EBONY FLAKE
DIRECTOR
3809 CROMWELL LANE
WILLIAMSBURG VA 23188

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/23/19
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development N.E.C.
Organization’s purpose Charitable: No
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 BRIAN SMALLS
Signature Title DIRECTOR
Signature Date 10/25/19

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