FORM 1023-EZ for PIECES OF HOME

Field Data
EIN 81-1330360
Case Number EO-2016109-000151
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PIECES OF HOME
Organization’s Mailing Address 4562 S FARM ROAD 189
City ROGERSVILLE
State MO
ZIP 65742
Accounting period End 12
Primary contact name JESSI GROVE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JESSI GROVE
PRESIDENT
4562 S FARM ROAD 189
ROGERSVILLE MO 65742

Officer/Director/Trustee Two

MACY MITCHELL
SECRETARY
275 E MILLER RD
REPUBLIC MO 65738

Officer/Director/Trustee Three

PAUL SATTERWHITE
TREASURER
3830 E POND APPLE DR
SPRINGFIELD MO 65809

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2016
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - 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 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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