FORM 1023-EZ for BREATH OF LIFE MISSION

Field Data
EIN 83-1202188
Case Number EO-2018253-000560
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BREATH OF LIFE MISSION
Organization’s Mailing Address 1608 BRENTWOOD STREET
City MIDDLETOWN
State OH
ZIP 45044
Accounting period End 12
Primary contact name TIM CAIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SEAN LAWRENCE
PASTOR
1608 BRENTWOOD STREET
MIDDLETOWN OH 45044

Officer/Director/Trustee Two

STEFANIE CAIN
ASSOCIATE PASTOR
2343 MIDDLETOWN EATON ROAD
MIDDLETOWN OH 45042

Officer/Director/Trustee Three

KEVIN LAWRENCE
BOARD VICE PRESIDENT
3909 HELTON APARTMENT 20
MIDDLETOWN OH 45044

Officer/Director/Trustee Four

TIM CAIN
BOARD PRESIDENT
2343 MIDDLETOWN EATON ROAD
MIDDLETOWN OH 45044

Officer/Director/Trustee Five

REBECCA LAWRENCE
TREASURER/SECRETARY
1608 BRENTWOOD STREET
MIDDLETOWN OH 45044

Organization’s website WWW.BREATHOFLIFEMISSION.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/29/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
Organization’s purpose Charitable: Yes
Religious: Yes
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SEAN LAWRENCE
Signature Title PASTOR
Signature Date 9/8/18

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