FORM 1023-EZ for HIS EYES SEE

Field Data
EIN 82-5305846
Case Number EO-2018136-000346
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HIS EYES SEE
Organization’s Mailing Address PO BOX 19366
City COLORADO CITY
State CO
ZIP 81019
Accounting period End 12
Primary contact name ANNA CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANNA CLARK
PRESIDENT
PO BOX 19381
COLORADO CITY CO 81019

Officer/Director/Trustee Two

PATRICIA JOHNSON
VICE PRESIDENT/TREASURER
10829 BARTLETT TRAIL
RYE CO 81069

Officer/Director/Trustee Three

CHRISTIE TRACY-NASH
SECRETARY
48 GREEN MOUNTAIN ST
WALSENBURG CO 81089

Officer/Director/Trustee Four

KATHY CLINE
BOARD MEMBER
105 REGENCY BLVD
PUEBLO CO 81005

Officer/Director/Trustee Five

ROB CHADWICK
BOARD MEMBER
PO BOX 20225
COLORADO CITY CO 81019

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/18
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 ANNA CLARK
Signature Title PRESIDENT
Signature Date 5/11/18

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