FORM 1023-EZ for GRACE HAVEN INCORPORATED
| Field | Data |
|---|---|
| EIN | 38-2339097 |
| Case Number | EO-2018106-000322 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | GRACE HAVEN INCORPORATED |
| Organization’s Mailing Address | 1040 FRANCIS |
| City | JACKSON |
| State | MI |
| ZIP | 49203 |
| Accounting period End | 12 |
| Primary contact name | DERRY PETTY |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
KEN ROBINSON
PRESIDENT
1042 WILLIAMS STREET
JACKSON MI 49203
Officer/Director/Trustee Two
SANDRA SMITH
SECRETARY
326 EAST EUCLID AVENUE
JACKSON MI 49203
Officer/Director/Trustee Three
CLYDE MCKANEY
TREASURER
2600 ALPINE LAKE APARTMENT A
JACKSON MI 49203
Officer/Director/Trustee Four
KERRY PETTY
BOARD MEMBER
POST OFFICE BOX 65333
BATON ROUGE MI 70806
Officer/Director/Trustee Five
DERRY PETTY
CHAIRMAN
337 OAK GROVE AVENUE APARTMENT I
JACKSON MI 49203
| Organization’s website | N/A |
|---|---|
| Organization’s email | GRACEHAVENHOMELESSCENTER@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/19/80 |
| Organization Incorporation State | MI |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P85 - Homeless Persons Centers, Services |
| 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 | 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 | Yes |
| Correctness Declaration | Yes |
| Signature Name | DERRY PETTY |
| Signature Title | CHAIRMAN |
| Signature Date | 4/10/18 |
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