FORM 1023-EZ for MOBILE OUTREACH ALLIANCE

Field Data
EIN 84-5037225
Case Number EO-2020157-000113
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOBILE OUTREACH ALLIANCE
Organization’s Mailing Address 8422 WEST 78TH CIRCLE
City ARVADA
State CO
ZIP 80005
Accounting period End 12
Primary contact name OLGA KOGAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

OLGA KOGAN
PRESIDENT
8422 WEST 78TH CIRCLE
ARVADA CO 80005

Officer/Director/Trustee Two

GREG HERNANDEZ
VP/SECRETARY
8422 WEST 78TH CIRCLE
ARVADA CO 80005

Officer/Director/Trustee Three

PAMELA BUTTS
TREASURER
8422 WEST 78TH CIRCLE
ARVADA CO 80005

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/2020
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 OLGA KOGAN
Signature Title PRESIDENT
Signature Date 6/3/2020

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