FORM 1023-EZ for FAMILY MENTOR FOUNDATION

Field Data
EIN 47-2504835
Case Number EO-2014357-000046
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FAMILY MENTOR FOUNDATION
Organization’s Mailing Address 6990 RIEBER STREET
City WORTHINGTON
State OH
ZIP 43085
Accounting period End 12
Primary contact name KARI VERNON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KARI VERNON
DIRECTOR, PRESIDENT
6990 RIEBER STREET
WORTHINGTON OH 43085

Officer/Director/Trustee Two

THOMAS VERNON
DIRECTOR, TREASURER
6990 RIEBER STREET
WORTHINGTON OH 43085

Officer/Director/Trustee Three

IRENE BOECKER
DIRECTOR, SECRETARY
9496 COUNTRY PATH TRAIL
DAYTON OH 45429

Organization’s website WWW.FAMILYMENTORFOUNDATION.ORG
Organization’s email KARI@FAMILYMENTORFOUNDATION.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/17/2014
Organization Incorporation State OH
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: 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
Signature Title
Signature Date

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