FORM 1023-EZ for HOOPS ON MISSION INC

Field Data
EIN 81-3794207
Case Number EO-2016263-000428
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOOPS ON MISSION INC
Organization’s Mailing Address 4127 RESIDENCE DR APT 407
City FORT MYERS
State FL
ZIP 33901
Accounting period End 12
Primary contact name SHANE NORTHROP CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALEX PAULEC
PRESIDENT
2670 BLUE CYPRESS LAKE CT
CAPE CORAL FL 33909

Officer/Director/Trustee Two

KARYNA BELTRAN JACKSON
VICE PRESIDENT
4127 RESIDENCE DR APT 407
FORT MYERS FL 33901

Officer/Director/Trustee Three

JEFF WHEELER
TREASURER
1145 DEL RIO DR
FORT MYERS FL 33901

Officer/Director/Trustee Four

HEIDI PAULEC
SECRETARY
2670 BLUE CYPRESS LAKE CT
CAPE CORAL FL 33909

Officer/Director/Trustee Five

BRIAN CULBERTSON
DIRECTOR
18180 N OLGA DR
ALVA FL 33920

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/10/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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