FORM 1023-EZ for ELIMISHA HOUSE INC

Field Data
EIN 85-1881187
Case Number EO-2020317-000241
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ELIMISHA HOUSE INC
Organization’s Mailing Address PO BOX 390
City HARLAN
State KY
ZIP 40831
Accounting period End 12
Primary contact name JANE S HENDRICKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JANE S HENDRICKSON
DIRECTOR PRESIDENT SECRETARY
103 ELMWAY
LOYALL KY 40854

Officer/Director/Trustee Two

RACHEL WHEELER
DIRECTOR TREASURER
194 WALNUT LOOP
HARLAN KY 40831

Officer/Director/Trustee Three

TINA BURKHART
DIRECTOR VICE PRESIDENT
107 GREEN STREET
LOYALL KY 40854

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/31/2020
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F21 - Alcohol, Drug Abuse, Prevention Only
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 JANE S HENDRICKSON
Signature Title DIRECTOR PRESIDENT SECRETARY
Signature Date 11/9/2020

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