FORM 1023-EZ for MOTHERS CHOICE USA INC

Field Data
EIN 47-3091233
Case Number EO-2015075-000582
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOTHERS CHOICE USA INC
Organization’s Mailing Address 18876 6495 ROAD
City MONTROSE
State CO
ZIP 81403
Accounting period End 12
Primary contact name GARY W STEPHENS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GARY W STEPHENS
PRESIDENT DIRECTOR
18876 6495 ROAD SECLUDED VALLEY R
MONTROSE CO 81403

Officer/Director/Trustee Two

WILLIAM A JOLLY
TREASURER DIRECTOR
163 PINEWOOD TRAIL
TRUMBULL CT 06611

Officer/Director/Trustee Three

MICHAEL E ZACHARIA
SECRETARY DIRECTOR
681 BONLEY COURT
FOLSOM CA 95630

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/18/2014
Organization Incorporation State DE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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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