FORM 1023-EZ for MIND MISSION

Field Data
EIN 83-1985821
Case Number EO-2018312-000047
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MIND MISSION
Organization’s Mailing Address 885 NORTHWEST BLVD
City COLUMBUS
State OH
ZIP 43212
Accounting period End 12
Primary contact name DEREK DAVIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TYLER ROLFES
OFFICER
944 HAMLET ST
COLUMBUS OH 43201

Officer/Director/Trustee Two

MARCUS MERRIMAN
OFFICER
1507 ELMWOOD AVE
COLUMBUS OH 43212

Officer/Director/Trustee Three

PHIL BRILLI
OFFICER
10167 CHELTON WOOD
POWELL OH 43065

Officer/Director/Trustee Four

TYSON HOUPE
OFFICER
2798 GATE WOOD RD
GRANDVIEW HEIGHTS OH 43212

Officer/Director/Trustee Five

DEREK DAVIS
FOUNDER
885 NORTHWEST BOULEVARD
COLUMBUS OH 43212

Organization’s website HTTPS://WWW.MINDMISSIONOHIO.COM/
Organization’s email MINDMISSIONDEREK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F12 - Fund Raising and/or Fund Distribution
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 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 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 DEREK DAVIS
Signature Title FOUNDER
Signature Date 11/5/18

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