FORM 1023-EZ for MOSAIC FORUM
| Field | Data |
|---|---|
| EIN | 82-4714933 |
| Case Number | EO-2019101-000178 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | MOSAIC FORUM |
| Organization’s Mailing Address | 6911 RICHMOND HIGHWAY SUITE 299B |
| City | ALEXANDRIA |
| State | VA |
| ZIP | 22306-1842 |
| Accounting period End | 12 |
| Primary contact name | JANE MORRISON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JANE MORRISON
EXECUTIVE DIRECTOR /EX-OFFICIO
6911 RICHMOND HIGHWAY STE 299B
ALEXANDRIA VA 22306-1842
Officer/Director/Trustee Two
MARTHA VILLANIGRO SANTIAGO
VP OF IMPLEMENTATION AND POLICY
6911 RICHMOND HIGHWAY STE 299B
ALEXANDRIA VA 22306-1842
Officer/Director/Trustee Three
MARTHA PEREA
DIRECTOR
8534 LINK HILLS LOOP
GAINESVILLE VA 20155-3244
| Organization’s website | WWW.MOSAICFORUM.ORG |
|---|---|
| Organization’s email | CONNECT@MOSAICFORUM.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 7/2/18 |
| Organization Incorporation State | VA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P50 - Personal Social 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 | 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 | JANE MORRISON |
| Signature Title | EXECUTIVE DIRECTOR /EX-OFFICIO |
| Signature Date | 4/9/19 |
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