FORM 1023-EZ for SAIAHS HOME

Field Data
EIN 81-0882946
Case Number EO-2016077-000035
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAIAHS HOME
Organization’s Mailing Address 611 90TH AVE SE
City WILLMAR
State MN
ZIP 56201
Accounting period End 12
Primary contact name ALISSA GALLINGER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JEREMY GALLINGER
DIRECTOR
611 90TH AVE SE
WILLMAR MN 56201

Officer/Director/Trustee Two

ALISSA GALLINGER
DIRECTOR
611 90TH AVE SE
WILLMAR MN 56201

Officer/Director/Trustee Three

JUSTIN HAYSLETT
DIRECTOR
8463 EMERY PKWY N
CHAMPLIN MN 55316

Officer/Director/Trustee Four

ALAYA HAYSLETT
DIRECTOR
8463 EMERY PKWY N
CHAMPLIN MN 55316

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/21/2015
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
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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