FORM 1023-EZ for MANTLE HOUSE MISSION

Field Data
EIN 27-4741745
Case Number EO-2015007-000346
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MANTLE HOUSE MISSION
Organization’s Mailing Address 636 BELLS MILLS ROAD
City WEST NEWTON
State PA
ZIP 15089-1842
Accounting period End 12
Primary contact name AL DUBOIS JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARCI ELSBURY
PRESIDENT
636 BELLS MILLS ROAD
WEST NEWTON PA 15089-1842

Officer/Director/Trustee Two

JONI KELLY
SECRETARY
380 FELL STREET
BELLE VERNON PA 15012

Officer/Director/Trustee Three

KEITH CORIGLIANO
TREASURER
6300 JACK STREET
FINLEYVILLE PA 15332

Officer/Director/Trustee Four

ED SLATE
BOARD MEMBER
303 N FOURTH STREET
WEST NEWTON PA 15089

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/27/2011
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L99 - Housing, Shelter 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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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