FORM 1023-EZ for SINGLEMOM MOTIVATED OPTIMISTIC MENTOR

Field Data
EIN 81-3761199
Case Number EO-2020056-000198
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SINGLEMOM MOTIVATED OPTIMISTIC MENTOR
Organization’s Mailing Address 4925 NORTH 12 TH STREET
City PHILADELPHIA
State PA
ZIP 19141
Accounting period End 12
Primary contact name SHAVON COLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TWANDA BAXTER
SECRETARY
6220 NORTH HOWARD STREET
PHILADELPHIA PA 19120

Officer/Director/Trustee Two

TINA KEOSEYAN
CFO
6532 NORTH MASHER
PHILADELPHIA PA 19120

Officer/Director/Trustee Three

MARIE GILLIS
MEMBER
719 KNORR STREET
PHILADELPHIA PA 19111

Officer/Director/Trustee Four

SHAVON COLE
CEO
4925 N 12 TH STREET
PHILADELPHIA PA 19141

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/6/2016
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P42 - Single Parent Agencies, 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 Yes
Correctness Declaration Yes
Signature Name SHAVON COLE
Signature Title CEO
Signature Date 2/23/2020

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