FORM 1023-EZ for MY BROTHERS KEEPER

Field Data
EIN 61-1737884
Case Number EO-2015015-000184
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY BROTHERS KEEPER
Organization’s Mailing Address 1334 CHAMBERS DR
City COLORADO SPRINGS
State CO
ZIP 80904
Accounting period End 12
Primary contact name SHAYNE MCDONALD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BONNIE MOEDER
TREASURER
1334 CHAMBERS DR
COLORADO SPRINGS CO 80904

Officer/Director/Trustee Two

ROBERT WORRALL
BOARD MEMBER
124 W LAS ANIMAS
COLORADO SPRINGS CO 80903

Officer/Director/Trustee Three

SHAYNE MCDONALD
PRESIDENT
1334 CHAMBERS DR
COLORADO SPRINGS CO 80904

Organization’s website MYBROTHERSKEEPERSOBERLIVING.COM
Organization’s email MYBROTHERSKEEPERSOBERLIVING@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/2014
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L40 - Low-Cost Temporary Housing
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 Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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
Signature Title
Signature Date

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