FORM 1023-EZ for REYNA SAFE HAVEN INC

Field Data
EIN 27-0047003
Case Number EO-2021116-000744
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name REYNA SAFE HAVEN INC
Organization’s Mailing Address 6960 RALEIGH STREET
City HOLLYWOOD
State FL
ZIP 33024
Accounting period End 12
Primary contact name RICHARD CHARLEMON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICHARD CHARLEMON
COO
6960 RALEIGH STREET
HOLLYWOOD FL 33024

Officer/Director/Trustee Two

RISSON CHARLEMON
CFO
6960 RALEIGH STREET
HOLLYWOOD FL 33024

Officer/Director/Trustee Three

TANIA ARISTIDE
TREASURER
6960 RALEIGH STREET
HOLLYWOOD FL 33024

Officer/Director/Trustee Four

AMY REYNA
BOARD
6960 RALEIGH STREET
HOLLYWOOD FL 33024

Officer/Director/Trustee Five

SAMANTHA CHARLEMON
SECRETARY
6960 RALEIGH STREET
HOLLYWOOD FL 33024

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/8/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth 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 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 RICHARD CHARLEMON
Signature Title COO
Signature Date 4/24/2021

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