FORM 1023-EZ for HIS REFUGE INC

Field Data
EIN 87-1094676
Case Number EO-2021224-000272
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HIS REFUGE INC
Organization’s Mailing Address 70515 BARTON RD
City SAINT CLAIRSVILLE
State OH
ZIP 43950
Accounting period End 12
Primary contact name HEIDI BERK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HEIDI BERK
DIRECTOR
70515 BARTON RD
SAINT CLAIRSVILLE OH 43950

Officer/Director/Trustee Two

EMILY TAYLOR
SECRETARY
2080 BATTLESBURG ST
EAST SPARTA OH 44626

Officer/Director/Trustee Three

WAYNE BERK
DIRECTOR
70515 BARTON RD
SAINT CLAIRSVILLE OH 43950

Officer/Director/Trustee Four

AMY STEWART
OFFICER
42727 WATERTOWER RD
BELMONT OH 43718

Officer/Director/Trustee Five

SUSIE LEWIS
TREASURER
39 OAK STREET
ST CLAIRSVILLE OH 43950

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/20/2021
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P32 - Foster Care
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 HEIDI BERK
Signature Title DIRECTOR
Signature Date 8/10/2021

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