FORM 1023-EZ for MOZAIC

Field Data
EIN 81-2309467
Case Number EO-2016116-000431
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOZAIC
Organization’s Mailing Address 21051 THOREAU CT
City STERLING
State VA
ZIP 20164
Accounting period End 10
Primary contact name RAGHAD BUSHNAQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RAGHAD BUSHNAQ
PRESIDENT, DIRECTOR
21051 THOREAU CT
STERLING VA 20164

Officer/Director/Trustee Two

MOUNA DARWICH
SECRETARY, DIRECTOR
21051 THOREAU CT
STERLING VA 20164

Officer/Director/Trustee Three

RANA HMAIDAN
TREASURER, DIRECTOR
21051 THOREAU CT
STERLING VA 20164

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/20/2016
Organization Incorporation State VA
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: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
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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