FORM 1023-EZ for MY BROTHERS KEEPER TLC

Field Data
EIN 81-4399462
Case Number EO-2017079-000389
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY BROTHERS KEEPER TLC
Organization’s Mailing Address 16893 TACK LANE
City MORENO VALLEY
State CA
ZIP 92555
Accounting period End 12
Primary contact name TANYA HUMPHREY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARNESHA BULLOCKS
PRESIDENT
1517 IRIS TRAIL
PERRIS CA 92571

Officer/Director/Trustee Two

CRYSTAL PRESBURY
SECRETARY
2219 GLIMMER WAY
PERRIS CA 92571

Officer/Director/Trustee Three

QUIANTA THOMAS
TREASURER
3062 RED CEDAR TRAIL
HEMET CA 92545

Officer/Director/Trustee Four

TANYA HUMPHREY
SECRETARY
4660 VICTORIA AVE APT 1701
RIVERSIDE CA 92507

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/12/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F32 - Community Mental Health Center
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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