FORM 1023-EZ for IMPACT MISSION RELIEF

Field Data
EIN 46-3824288
Case Number EO-2014351-000213
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name IMPACT MISSION RELIEF
Organization’s Mailing Address 8313 SOUTHWEST FREEWAY SUITE 211
City HOUSTON
State TX
ZIP 77074
Accounting period End 3
Primary contact name PAUL WEMBOLENGA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PAUL WEMBOLENGA
PRESIDENT CEO
7979 WESTHEIMER ROAD APT 2607
HOUSTON TX 77063

Officer/Director/Trustee Two

ANTHONY MULISYA
SENIOR PROGRAM DIRECTOR
8530 OLDBROOK DRIVE
HOUSTON TX 77071

Officer/Director/Trustee Three

BOB GEORGIA
EMERGENCY RELIEF DIRECTOR
921 E MULBERRY STREET
ANGLETON TX 77515

Officer/Director/Trustee Four

JEAH ZIATIE
NATIONAL DIRECTOR
8957 SOUTH GESSNER DR APT 180
HOUSTON TX 77074

Organization’s website
Organization’s email IMPACTMISSIONRELIEF@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/7/2013
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q33 - International Relief
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance Yes
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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