FORM 1023-EZ for EPA-EMP ORIGINAL GOOD

Field Data
EIN 47-4147107
Case Number EO-2019142-000334
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EPA-EMP ORIGINAL GOOD
Organization’s Mailing Address 1396 CAMELIA DRIVE
City EAST PALO ALTO
State CA
ZIP 94303
Accounting period End 7
Primary contact name GWENDOLYN P CARSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM BAILEY
TREASURER
1396 CAMELIA DRIVE
EAST PALO ALTO CA 94303

Officer/Director/Trustee Two

ROSEVELT JORDAN
SECRETARY
1396 CAMELIA DRIVE
EAST PALO ALTO CA 94303

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/14
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name WILLIAM BAILEY
Signature Title TREASURER
Signature Date 5/20/19
EIN 47-4147107
Case Number EO-2015348-000365
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EPA-EMP ORIGINAL GOOD
Organization’s Mailing Address 1396 CAMELLIA DRIVE
City EAST PALO ALTO
State CA
ZIP 94303
Accounting period End 7
Primary contact name LAVELL PENNINGTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT HAMEL
PRESIDENT
2280 LATHAM ST
MT. VIEW CA 94040

Officer/Director/Trustee Two

WILLIAM BAILEY
TREASURER
2041 HARBOR VIEW AVE
SAN JOSE CA 95122

Officer/Director/Trustee Three

ROOSEVELT JORDAN
SECRETARY
919 MOWRY AVE
FREMONT CA 94536

Officer/Director/Trustee Four

LAVELL PENNINGTON
BUSINESS MANAGER
792 FERNDALE COURT
SAN JOSE CA 95133

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
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 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
Signature Title
Signature Date

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