FORM 1023-EZ for YOUR OTHER MOTHER INC

Field Data
EIN 82-3899331
Case Number EO-2018150-000130
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name YOUR OTHER MOTHER INC
Organization’s Mailing Address 16 S WASHINGTON AVENUE
City UNION
State MO
ZIP 63084
Accounting period End 12
Primary contact name JAMIE PATEKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMIE PATAKY
PRESIDENT
302 CRESTHAVEN PLACE
NEW HAVEN MO 63068

Officer/Director/Trustee Two

KIMBERLY CARROLL
VICE PRESIDENT
3929 HWY A
UNION MO 63084

Officer/Director/Trustee Three

AMBER JACQUIN
SECRETARY
201 GREENSTREET ROAD
BEAUFORT MO 63013

Officer/Director/Trustee Four

JENNIFER PHELPS
TREASURER
1345 W MAIN STREET
UNION MO 63084

Organization’s website HTTPS//YOUROTHERMOTHER112.WIXSITE.COM/HOPE4MOMS
Organization’s email YOUROTHERMOTHER1121@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/21/17
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
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 JAMIE PATAKY
Signature Title PRESIDENT
Signature Date 5/24/18

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