FORM 1023-EZ for JERUBYS HAVEN INC

Field Data
EIN 85-3468903
Case Number EO-2020304-000101
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JERUBYS HAVEN INC
Organization’s Mailing Address 5347 NORTH 51ST BOULEVARD
City MILWAUKEE
State WI
ZIP 53218
Accounting period End 12
Primary contact name DOROTHY KIDWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOROTHY KIDWELL
PRESIDENT
5347 NORTH 51STS BOULEVARD
MILWAUKEE WI 53218

Officer/Director/Trustee Two

THERESA BELLONE
VICE PRESIDENT
7201 EARL AVENUE
GREENDALE WI 53129

Officer/Director/Trustee Three

KIMBERLY LOWE
TREASURER
3825 WEST VERA
MILWAUKEE WI 53209

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/14/2020
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: Yes
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 DOROTHY KIDWELL
Signature Title PRESIDENT
Signature Date 10/28/2020

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