FORM 1023-EZ for BAILEYS MOM LLC

Field Data
EIN 81-1969904
Case Number EO-2016266-000168
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BAILEYS MOM LLC
Organization’s Mailing Address 1332 GOLDENROD PLACE
City NAMPA
State ID
ZIP 83686-7105
Accounting period End 12
Primary contact name TERRENCE A BLOM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERRENCE BLOM
DIRECTOR
1332 GOLDENROD PLACE
NAMPA ID 83686-7105

Officer/Director/Trustee Two

SARAH KELLY
DIRECTOR
6925 W PREECE
BOISE ID 83704-8678

Officer/Director/Trustee Three

JEANETTE RODRIQUEZ
BOARD MEMBER
14415 N PRESIDIO LOOP
NAMPA ID 83651-7540

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/14/2016
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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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