FORM 1023-EZ for MAMA GS HOME FOR TEENS INC

Field Data
EIN 82-4493143
Case Number EO-2018155-000338
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MAMA GS HOME FOR TEENS INC
Organization’s Mailing Address 7210 NORTH MANHATTAN AVE SUITE 1524
City TAMPA
State FL
ZIP 33614-3726
Accounting period End 12
Primary contact name CHEYENNE JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN SHEID
CEO
7210 N MANHATTAN AVE
TAMPA FL 33614-3726

Officer/Director/Trustee Two

GINGER ROCKEY-JOHNSON
COO
7210 N MANHATTAN AVE
TAMPA FL 33614-3726

Officer/Director/Trustee Three

CHEYENNE JOHNSON
TREASURER
7210 N MANHATTAN AVE
TAMPA FL 33614-3726

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/22/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P73 - Group Home (Long Term)
Organization’s purpose Charitable: Yes
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 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 CHEYENNE JOHNSON
Signature Title TREASURER
Signature Date 6/1/18

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