FORM 1023-EZ for BLOOM FOUNDATION INC

Field Data
EIN 82-2243041
Case Number EO-2018039-000062
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLOOM FOUNDATION INC
Organization’s Mailing Address 7 MOJO COURT
City NEWPORT BEACH
State CA
ZIP 92663
Accounting period End 1
Primary contact name ANDREA LONG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA LONG
PRESIDENT
7 MOJO COURT
NEWPORT BEACH CA 92663

Officer/Director/Trustee Two

LOREN MITTERMILLER
TREASURER
4216 HILARIA WAY
NEWPORT BEACH CA 92663

Officer/Director/Trustee Three

MALORY GUENOUNE
SECRETARY
36 FOX HOLW
IRVINE CA 92614

Organization’s website
Organization’s email ANDILONG8@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O30 - Adult, Child Matching Programs
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 ANDREA LONG
Signature Title PRESIDENT
Signature Date 2/5/18

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