FORM 1023-EZ for A MOTHERS KEEPER

Field Data
EIN 83-2560960
Case Number EO-2018324-000095
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A MOTHERS KEEPER
Organization’s Mailing Address 7103 KELLA WAY
City MECHANICSVILLE
State VA
ZIP 23111-2422
Accounting period End 12
Primary contact name DAYNA CLEVELAND COBB
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAYNA CLEVELAND COBB
DIRECTOR
7103 KELLA WAY
MECHANICSVILLE VA 23111-2422

Officer/Director/Trustee Two

STACY BURLESON
DIRECTOR
11360 BRIDLEWOOD DRIVE
UNIONVILLE VA 22567-3446

Officer/Director/Trustee Three

NA NA
NA
NA
NA VA 23111-2422

Officer/Director/Trustee Four

NA NA
NA
NA
NA VA 23111-2422

Officer/Director/Trustee Five

NA NA
NA
NA
NA VA 23111-2422

Organization’s website WWW.AMOTHERSKEEPER.COM
Organization’s email DAYNA@AMOTHERSKEEPER.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/5/18
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, 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 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 DAYNA CLEVELAND COBB
Signature Title DIRECTOR
Signature Date 11/18/18

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