FORM 1023-EZ for HAVEN ROSE FOUNDATION

Field Data
EIN 84-4871491
Case Number EO-2020090-000145
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HAVEN ROSE FOUNDATION
Organization’s Mailing Address PO BOX 1885
City CLACKAMAS
State OR
ZIP 97015-1885
Accounting period End 12
Primary contact name BECKY KLOTZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSICA RIES
PRESIDENT
PO BOX 1885
CLACKAMAS OR 97015-1885

Officer/Director/Trustee Two

JULIE HAUGEN
VICE PRESIDENT
PO BOX 1885
CLACKAMAS OR 97015-1885

Officer/Director/Trustee Three

BECKY KLOTZ
TREASURER
PO BOX 1885
CLACKAMAS OR 97015-1885

Officer/Director/Trustee Four

ALLIE DRAKE
SECRETARY/CLIENT COMMITTEE CHAIR
PO BOX 1885
CLACKAMAS OR 97015-1885

Organization’s website
Organization’s email HAVENROSEFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/26/2020
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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 BECKY KLOTZ
Signature Title TREASURER
Signature Date 3/26/2020

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