FORM 1023-EZ for MOSAIC HOUSE MINISTRIES

Field Data
EIN 47-5437860
Case Number EO-2015306-000349
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOSAIC HOUSE MINISTRIES
Organization’s Mailing Address 1644 PARK AVE
City NORTH CHICAGO
State IL
ZIP 60064
Accounting period End 12
Primary contact name MARY FUNK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DANIEL HARTMAN
DIRECTOR/REGISTERED AGENT
1644 PARK AVE
NORTH CHICAGO IL 60064

Officer/Director/Trustee Two

PETER CHA
PRESIDENT/CHIEF EXECUTIVE OFFICER
22 LONDONBERRY
LINCOLNSHIRE IL 60069

Officer/Director/Trustee Three

MARY FUNK
SECRETARY/TREASURER
820 S GREEN BAY RD
LAKE FOREST IL 60045

Officer/Director/Trustee Four

HARRY STACKHOUSE
BOARD MEMBER
20550 W GRASSLAKE RD
LAKE VILLA IL 60046

Officer/Director/Trustee Five

IKE HONG
BOARD MEMBER
11 BROADLEYS COURT
BANNOCKBURN IL 60015

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
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 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 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
Signature Title
Signature Date

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