FORM 1023-EZ for MOUNTAINS TO THE SEA MINISTRIES INCORPORATED

Field Data
EIN 87-2244876
Case Number EO-2021239-000419
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOUNTAINS TO THE SEA MINISTRIES INCORPORATED
Organization’s Mailing Address 386 S ATLANTIC AVE UNIT 26
City ORMOND BEACH
State FL
ZIP 32176
Accounting period End 12
Primary contact name DLORAH BUTTS-LUCAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES POLOVICH
PRESIDENT & DIRECTOR
21 ORIOLE CIRCLE UNIT B
ORMOND BEACH FL 32176

Officer/Director/Trustee Two

CHRISTINA POLOVICH
DIRECTOR & SECRETARY
21 ORIOLE CIRCLE UNIT B
ORMOND BEACH FL 32176

Officer/Director/Trustee Three

TAMI CARLUCCI-FIELDS
DIRECTOR
476 WILTSHIRE BLVD
PORT ORANGE FL 32127

Officer/Director/Trustee Four

DONALD GEORGER
DIRECTOR
730 S BEACH ST UNIT 1
ORMOND BEACH FL 32174

Officer/Director/Trustee Five

LAWRENCE LEMONCELLO
DIRECTOR
138 SEA TRAIL
PALM COAST FL 32164

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Donation of funds Yes
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 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 JAMES POLOVICH
Signature Title PRESIDENT & DIRECTOR
Signature Date 8/25/2021

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