FORM 1023-EZ for RESTORATIVE LIVING SUPPORTIVE HOUSING INC

Field Data
EIN 87-1189503
Case Number EO-2021181-000186
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RESTORATIVE LIVING SUPPORTIVE HOUSING INC
Organization’s Mailing Address 46737 WILLOW FORREST LANE
City LEXINGTON PARK
State MD
ZIP 20653
Accounting period End 12
Primary contact name RENEE MOSS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RENEE MOSS
CEO
46737 WILLOW FOREST LN
LEXINGTON PARK MD 20653-3827

Officer/Director/Trustee Two

ELISA HEIGHT
DIRECTOR
45679 EDGE MILL CT
GREAT MILLS MD 20634

Officer/Director/Trustee Three

JUWANA BROADUS
DIRECTOR
23587 BELMAR DRIVE
LEONARDTOWN MD 20650

Officer/Director/Trustee Four

PAM FORD
DIRECTOR
6104 TAPIR PLACE
WALDORF MD 20601

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/14/2021
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 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 RENEE MOSS
Signature Title CEO
Signature Date 6/28/2021

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