FORM 1023-EZ for ADONAI SHALOM USA

Field Data
EIN 85-3121041
Case Number EO-2020268-000432
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADONAI SHALOM USA
Organization’s Mailing Address 7324 BRAMBLEWOOD RD
City FORTH WORTH
State TX
ZIP 76133
Accounting period End 12
Primary contact name JOEL INCORVAIA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RETA MULUKEN
PRESIDENT AND DIRECTOR
7324 BRAMBLEWOOD ROAD
FORTH WORTH TX 76133

Officer/Director/Trustee Two

PARTHENIA ANTOINE
TREASURER AND DIRECTOR
7324 BRAMBLEWOOD ROAD
FORTH WORTH TX 76133

Officer/Director/Trustee Three

DAWITT DEJENE
SECRETARY AND DIRECTOR
7324 BRAMBLEWOOD ROAD
FORTH WORTH TX 76133

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/16/2020
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X21 - Protestant
Organization’s purpose Charitable: No
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 No
Donation of funds No
Conducting Activities Outside of United States Yes
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 PARTHENIA ANTOINE
Signature Title TREASURER AND DIRECTOR
Signature Date 9/22/2020

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