FORM 1023-EZ for MELPHOMENE BROTHERS FOUNDATION

Field Data
EIN 83-0842159
Case Number EO-2018164-000227
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MELPHOMENE BROTHERS FOUNDATION
Organization’s Mailing Address 2218 NW ASHLAND PRKWAY
City ANKENY
State IA
ZIP 50023
Accounting period End 9
Primary contact name MARCUS GOINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARCUS GOINS
DIRECTOR
2218 NW ASHLAND PRKWAY
ANKENY IA 50023

Officer/Director/Trustee Two

BRIAN GOINS
DIRECTOR
2521 MARTIN LUTHER KING BLVD
NEW ORLEANS LA 70113

Officer/Director/Trustee Three

ZERRICK HAYMOND
DIRECTOR
313 LINCOLN DR
BILOXI MS 39531

Officer/Director/Trustee Four

JASON KECKI
DIRECTOR
117 1/2 FIRST AVE WEST
OSKALOOSA IA 52577

Officer/Director/Trustee Five

KIMBERLY LAVALEE
DIRECTOR
1931 WILSON AVE
AMES IA 50010

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/18
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T30 - Public Foundations
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 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 MARCUS GOINS
Signature Title DIRECTOR
Signature Date 6/11/18

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