FORM 1023-EZ for EBENEZER GOSPEL MISSION

Field Data
EIN 11-3414782
Case Number EO-2018064-000382
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EBENEZER GOSPEL MISSION
Organization’s Mailing Address PO BOX 20068
City HUNTINGTON STATION
State NY
ZIP 11746-851
Accounting period End 12
Primary contact name SAM CHACKO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SAM CHACKO
DIRECTOR
117 VILLAGE HILL DRIVE
DIX HILLS NY 11746

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/97
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X19 - Nonmonetary Support N.E.C.
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SAM CHACKO
Signature Title DIRECTOR
Signature Date 3/2/18

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