FORM 1023-EZ for MOTHERLAND HEALTH

Field Data
EIN 82-5460680
Case Number EO-2019065-000303
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOTHERLAND HEALTH
Organization’s Mailing Address 3027 23RD AVE S UNIT D
City FARGO
State ND
ZIP 58103
Accounting period End 8
Primary contact name SIMILOLUWA KASAKWE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SIMILOLUWA KASAKWE
BUSINESS COORDINATOR
3027 23RD AVE S UNIT D
FARGO ND 58103

Organization’s website MOTHERLANDHEALTH.ORG
Organization’s email INFO@MOTHERLANDHEALTH.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/13/18
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 SIMILOLUWA KASAKWE
Signature Title BUSINESS COORDINATOR
Signature Date 3/4/19

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