FORM 1023-EZ for MOSAIC LIFE INC

Field Data
EIN 85-1851600
Case Number EO-2020196-000676
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOSAIC LIFE INC
Organization’s Mailing Address 234 OKEECHOBEE W
City SANTA ROSA BEACH
State FL
ZIP 32459
Accounting period End 12
Primary contact name MARCIA BUTCHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN WALLACE
DIRECTOR
45 WOODBRIAR DR
SANTA ROSA BEACH FL 32459

Officer/Director/Trustee Two

ANDY BUTCHER
DIRECTOR
234 OKEECHOBEE W
SANTA ROSA BEACH FL 32459

Officer/Director/Trustee Three

MARCIA BUTCHER
DIRECTOR
234 OKEECHOBEE W
SANTA ROSA BEACH FL 32459

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/30/2020
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 MARCIA BUTCHER
Signature Title DIRECTOR
Signature Date 7/12/2020

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