FORM 1023-EZ for NLH FOUNDATION CORPORATION

Field Data
EIN 82-1133024
Case Number EO-2017103-000468
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NLH FOUNDATION CORPORATION
Organization’s Mailing Address 5608 OAK HILL CIRCLE
City RENSSELAER
State NY
ZIP 12144-8813
Accounting period End 12
Primary contact name LAVERNE HANSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAVERNE HANSEN
CEO
5608 OAK HILL CIRCLE
RENSSELAER NY 12144-8813

Officer/Director/Trustee Two

NANCY HANSEN
SECRETARY
5608 OAK HILL CIRCLE
RENSSELAER NY 12144-8813

Officer/Director/Trustee Three

LEE HANSEN
VICE PRESIDENT
5608 OAK HILL CIRCLE
RENSSELAER NY 12144-8813

Organization’s website
Organization’s email SCCOFFEECAKE@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/7/2017
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G99 - Diseases, Disorders, Medical Disciplines N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: Yes
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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