FORM 1023-EZ for HERSTORY INC

Field Data
EIN 81-1009951
Case Number EO-2016155-000207
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HERSTORY INC
Organization’s Mailing Address PO BOX 212
City XENIA
State OH
ZIP 45385
Accounting period End 12
Primary contact name WHITNEY CAUDILL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WHITNEY CAUDILL
PRESIDENT
2952 WEST BARNHILL PLACE
XENIA OH 45385

Officer/Director/Trustee Two

TIMOTHY ROOP
CHAIRMAN
760 NIAGARA TRAIL
JAMESTOWN OH 45335

Officer/Director/Trustee Three

SANDRA WAGNER
SECRETARY
893 SOUTH DETROIT STREET
XENIA OH 45385

Officer/Director/Trustee Four

RUTH CAUDILL
DIRECTOR
1776 PARKVIEW DRIVE
XENIA OH 45835

Officer/Director/Trustee Five

CHRISTINA WATSON
DIRECTOR
264 ORCHARD STREET
XENIA OH 45385

Organization’s website WWW.HERSTORYHOUSE.COM
Organization’s email INFO@HERSTORYHOUSE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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