FORM 1023-EZ for THE MOSAIC INITIATIVE
| Field | Data |
|---|---|
| EIN | 85-1407698 |
| Case Number | EO-2020211-000411 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | THE MOSAIC INITIATIVE |
| Organization’s Mailing Address | 3502 S MARKET ST |
| City | MARION |
| State | IL |
| ZIP | 62959 |
| Accounting period End | 12 |
| Primary contact name | HALEY OTTOLINI |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
ALISON ROCK
PRESIDENT OF BOARD OF DIRECTORS
315 BRIARWOOD DR
WATERLOO IL 62298
Officer/Director/Trustee Two
JACKSON CLIFFORD
TREASURER OF BOARD OF DIRECTORS
5870 SOLOMON HARMON WAY
WHITESTOWN IN 46075
Officer/Director/Trustee Three
HALEY OTTOLINI
EXECUTIVE DIRECTOR/ FOUNDER
3502 S MARKET ST
MARION IL 62959
Officer/Director/Trustee Four
ZACK MYERS
SECRETARY OF BOARD OF DIRECTORS
2025 WEXFORD GREEN WAY
BELLEVILLE IL 62220
Officer/Director/Trustee Five
EMILY MYERS
BOARD OF DIRECTORS
2025 WEXFORD GREEN WAY
BELLEVILLE IL 62220
| Organization’s website | WWW.THEMOSAICINITIATIVE.ORG |
|---|---|
| Organization’s email | CONNECT@THEMOSAICINITIATIVE.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 2/5/2020 |
| Organization Incorporation State | IN |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | I73 - Sexual Abuse, Prevention of |
| Organization’s purpose | Charitable: Yes Religious: Yes 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 | Yes |
| 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 | HALEY OTTOLINI |
| Signature Title | EXECUTIVE DIRECTOR/ FOUNDER |
| Signature Date | 7/27/2020 |
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