FORM 1023-EZ for MY IMPACT

Field Data
EIN 47-1042675
Case Number EO-2015322-000247
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY IMPACT
Organization’s Mailing Address 861 PARK COURT UNIT C
City MOUNTAIN VIEW
State CA
ZIP 94040-2521
Accounting period End 9
Primary contact name RYAN MONGUILLOT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RYAN MONGUILLOT
FOUNDER
861 PARK COURT UNIT C
MOUNTAIN VIEW CA 94040-2521

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/24/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G20 - Birth Defects and Genetic Diseases
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 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
Signature Title
Signature Date

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