FORM 1023-EZ for HOUSE OF MIRIAM INC

Field Data
EIN 85-4105145
Case Number EO-2021049-000036
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HOUSE OF MIRIAM INC
Organization’s Mailing Address 320 OLD LANCASTER RD
City DEVON
State PA
ZIP 19333
Accounting period End 12
Primary contact name ANDREW SIMON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREW SIMON
PRESIDENT
320 OLD LANCASTER RD
DEVON PA 19333

Officer/Director/Trustee Two

DONNA LAWRENCE
CEO
220 LOWER SAHLER MILL RD
OLIVEBRIDGE NY 12461

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/8/2020
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T40 - Voluntarism Promotion
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 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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ANDREW SIMON
Signature Title PRESIDENT
Signature Date 12/22/2020

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