FORM 1023-EZ for CROSS MOUNTAIN MISSION INC

Field Data
EIN 85-2290973
Case Number EO-2020231-000115
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CROSS MOUNTAIN MISSION INC
Organization’s Mailing Address PO BOX 11
City FRENCH CAMP
State MS
ZIP 39745
Accounting period End 12
Primary contact name MARCUS ADAM BLAYLOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARCUS ADAM BLAYLOCK
PRESIDENT
1 FINE PLACE
FRENCH CAMP MS 39745

Officer/Director/Trustee Two

BRANDON BROCK
TREASURER
23 TWO OAKS DR
ST HELENA SC 29920

Officer/Director/Trustee Three

SHANE OLSEN
CHAIRPERSON
PO BOX 4737
BEAUFORT SC 29903

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/2020
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q33 - International Relief
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Donation of funds No
Conducting Activities Outside of United States Yes
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 MARCUS ADAM BLAYLOCK
Signature Title PRESIDENT
Signature Date 8/15/2020

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