FORM 1023-EZ for HOUSE OF MEPHIBOSHETH INC

Field Data
EIN 35-2424702
Case Number EO-2017116-000327
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOUSE OF MEPHIBOSHETH INC
Organization’s Mailing Address 163 RICHMOND AVE
City BUFFALO
State NY
ZIP 14222
Accounting period End 12
Primary contact name JAMES THOMAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES THOMAS
EXECUTIVE DIRECTOR
163 RICHMOND AVE
BUFFALO NY 14222

Officer/Director/Trustee Two

STEPHANIE LEE
PRESIDENT
56 LONGVIEW AVE
BUFFALO NY 14215

Officer/Director/Trustee Three

FAYE SCOTT
VICE PRESIDENT
43 FENNIMORE AVE
BUFFALO NY 14215

Officer/Director/Trustee Four

LOUIS MARTIN
SECRETARY/TREASURER
240 PARK AVE
DUNKIRK NY 14048

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2017
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
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 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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