FORM 1023-EZ for HOME OUTREACH

Field Data
EIN 81-3442726
Case Number EO-2016221-000183
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOME OUTREACH
Organization’s Mailing Address 14100 COVENTRY WAY UNIT 303
City TUSTIN
State CA
ZIP 92782
Accounting period End 6
Primary contact name RICHARD GARMAN CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BILL NELSON
DIRECTOR
968 PRESIDO DR
COSTA MESA CA 92626

Officer/Director/Trustee Two

JOHN BEGIN
PRESIDENT
14100 COVENTRY WAY UNIT 303
TUSTIN CA 92782

Officer/Director/Trustee Three

JAMES MAULDIN
DIRECTOR
910 ACADIA AVE
HUNTINGTON BEACH CA 92648

Officer/Director/Trustee Four

DAVID BLITZ
TREASURER
8802 LANARCK CIRCLE
HUNTINGTON BEACH CA 92646

Officer/Director/Trustee Five

KEITH JORGENSEN
SECRETARY
3212 PORTOFINO CIRCLE
HUNTINGTON BEACH CA 92649

Organization’s website
Organization’s email JBEGIN@COSTAMESACOC.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/12/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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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