FORM 1023-EZ for DISABILITY SUPPORT SERVICES

Field Data
EIN 81-4477252
Case Number EO-2016328-000228
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DISABILITY SUPPORT SERVICES
Organization’s Mailing Address 4339 JACK ALAN ST SW
City GRANDVILLE
State MI
ZIP 49418
Accounting period End 12
Primary contact name BRYANT DOMINA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRYANT DOMINA
DIRECTOR
4339 JACK ALAN ST
GRANDVILLE MI 49418

Officer/Director/Trustee Two

MARK HOFSTEE
DIRECTOR
3996 CHICAGO DR SW
GRANDVILLE MI 49418

Officer/Director/Trustee Three

DOUG BOOMSMA
DIRECTOR
5775 BALSAM DR
HUDSONVILLE MI 49426

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/26/2016
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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
Signature Title
Signature Date

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