FORM 1023-EZ for A HEALTHFUL VILLAGE INC

Field Data
EIN 81-3481443
Case Number EO-2016285-000471
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name A HEALTHFUL VILLAGE INC
Organization’s Mailing Address 1300 W WARNER RD SUITE 1023
City GILBERT
State AZ
ZIP 85233
Accounting period End 12
Primary contact name MICHAEL SHILLINGBURG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL SHILLINGBURG
CHAIRMAN
1300 W WARNER RD 1023
GILBERT AZ 85233

Officer/Director/Trustee Two

DANICA SHILLINGBURG
SECERATARY
1300 W WARNER RD 1023
GILBERT AZ 85233

Officer/Director/Trustee Three

JENNIFER BOTTER
DIRECTOR
2751 E CARLA VISTA DR
CHANDLER AZ 85225

Officer/Director/Trustee Four

GRACE PIERSON
DIRECTOR
3225 E BASELINE RD 2013
GILBERT AZ 85234

Officer/Director/Trustee Five

ASHLEE LAVERGNE
DIRECTOR
3273 E MORNING STAR LN
GILBERT AZ 85298

Organization’s website AHEALTHFULVILLAGE.ORG
Organization’s email CONTACT@AHEALTHFULVILLAGE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/3/2016
Organization Incorporation State AZ
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 Yes
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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