FORM 1023-EZ for LANE HAITIAN RELIEF

Field Data
EIN 38-3895453
Case Number EO-2018106-000744
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LANE HAITIAN RELIEF
Organization’s Mailing Address 4557 KIWANDA STREET
City FLORENCE
State OR
ZIP 97439-9139
Accounting period End 12
Primary contact name SNELL FONRTUS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SNELL FONTUS
PRESIDENT
4557 KIWANDA ST
FLORENCE OR 97439-9139

Officer/Director/Trustee Two

CARRIE-LYN GREEN
SECRETARY
4557 KIWANDA ST
FLORENCE OR 97439-9139

Officer/Director/Trustee Three

NICK GIDEONSE
TREASURER
4557 KIWANDA ST
FLORENCE OR 97439-9139

Officer/Director/Trustee Four

KAREN KWONG
BOARD DIRECTORS
4557 KIWANDA ST
FLORENCE OR 97439-9139

Officer/Director/Trustee Five

GORDON JOHNSON
BOARD DIRECTORS
4557 KIWANDA ST
FLORENCE OR 97439-9139

Organization’s website HTTPS://LANEHAITIANRELIEF.WORDPRESS.COM/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/27/12
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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 SNELL FONTUS
Signature Title PRESIDENT
Signature Date 4/3/18

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