FORM 1023-EZ for HOUSE OF PRISM INC

Field Data
EIN 84-4908167
Case Number EO-2020174-000323
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HOUSE OF PRISM INC
Organization’s Mailing Address PO BOX 828
City ST AUGUSTINE
State FL
ZIP 32085
Accounting period End 12
Primary contact name TRAVIS BARTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TRAVIS BARTON
DIRECTOR
20 DALLYON AVE
ST AUGUSTINE FL 32080

Officer/Director/Trustee Two

SARA BLOOMBERG
DIRECTOR
161 BLANCO
ST AUGUSTINE FL 32084

Officer/Director/Trustee Three

ZACHERY DRILINGAS
DIRECTOR
61 MOULTRIE
ST AUGUSTINE FL 32086

Officer/Director/Trustee Four

MARY ODONOGHUE
DIRECTOR
96 KETIH ST
ST AUGUSTINE FL 32084

Organization’s website WWW.HOUSEOFPRISM.ORG
Organization’s email HOUSEOFPRISMINC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/20/2020
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P88 - LGBTQ Centers
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 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 TRAVIS BARTON
Signature Title DIRECTOR
Signature Date 6/19/2020

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