FORM 1023-EZ for A HOME AWAY FROM HOME

Field Data
EIN 81-4657545
Case Number EO-2017079-000050
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name A HOME AWAY FROM HOME
Organization’s Mailing Address 706A SASSAFRAS DR
City STARKVILLE
State MS
ZIP 39759
Accounting period End 12
Primary contact name ANGELA SHERMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANGELA SHERMAN
PRESIDENT
706 A SASSAFRAS DRIVE
STARKVILLE MS 39759

Officer/Director/Trustee Two

TIMEKA BROWN GARTH
SECRETARY
125 JOSEY AVE
STAKVILLE MS 39759

Officer/Director/Trustee Three

TEMORRIS SHERMAN
TREASURER
706 A SASSAFRAS DRIVE
STARKVILLE MS 39759

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/28/2016
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P75 - Senior Continuing Care Communities
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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