FORM 1023-EZ for MISSION IMPACT ALLIANCE

Field Data
EIN 47-4029717
Case Number EO-2015327-000432
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MISSION IMPACT ALLIANCE
Organization’s Mailing Address 4110 SE HAWTHORNE BLVD NO 924
City PORTLAND
State OR
ZIP 97214
Accounting period End 12
Primary contact name JACOB NELSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JACOB NELSON
PRESIDENT
2335 NE CLEVELAND AVENUE
GRESHAM OR 97030

Officer/Director/Trustee Two

JULIE BOWER
SECRETARY
5397 FLORIDA AVENUE
BETHEL PARK PA 15102

Officer/Director/Trustee Three

ANNA MARIE MARTINO
TREASURER
1910 SW OLD SHERIDAN RD APT C303
MCMINNVILLE OR 97128

Officer/Director/Trustee Four

RICKY ANDRADE
BOARD MEMBER
4799 HARBINSON AVENUE
LA MESA CA 91942-8754

Officer/Director/Trustee Five

OLE HAYNES
BOARD MEMBER
625 SUNSET DRIVE
KETCHIKAN AK 99901

Organization’s website HTTP://MISSIONIMPACTALLIANCE.ORG/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/23/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: Yes
Educational: Yes
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
Signature Title
Signature Date

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