FORM 1023-EZ for FIVE LOAVES MOBILE FOOD PANTRY INC

Field Data
EIN 38-3824396
Case Number EO-2018071-000356
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FIVE LOAVES MOBILE FOOD PANTRY INC
Organization’s Mailing Address 7251 S SOUTHSHORE DRIVE NO 19C
City CHICAGO
State IL
ZIP 60649
Accounting period End 12
Primary contact name JAMAL JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EBONI SAMPSON
PRESIDENT
7251 S SOUTHSHORE DRIVE NO 19C
CHICAGO IL 60649

Officer/Director/Trustee Two

ERIC MCLEAN
TREASURER
3337 S KIRKMAN ROAD APT 623
ORLANDO FL 32811

Officer/Director/Trustee Three

REGINA MATTHEWS
SECRETARY
5752 CRESTWOOD ROAD
MATTESON IL 60443

Officer/Director/Trustee Four

REYNOLDS WINTERSMITH
DIRECTOR
3041 W CULLERTON STREET
CHICAGO IL 60623

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/17
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
Correctness Declaration Yes
Signature Name EBONI SAMPSON
Signature Title PRESIDENT
Signature Date 3/9/18

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