FORM 1023-EZ for SHASTAS ELDERCARE REFERRAL INC

Field Data
EIN 85-1212819
Case Number EO-2020252-000376
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHASTAS ELDERCARE REFERRAL INC
Organization’s Mailing Address 8334 MCKINLEY AVE
City CENTERLINE
State MI
ZIP 48015
Accounting period End 6
Primary contact name SHASTA SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHASTA SMITH
PRESIDENT
8334 MCKINLEY AVE
CENTERLINE MI 48015

Officer/Director/Trustee Two

IAN TINGLE
VICE PRESIDENT
8334 MCKINLEY AVE
CENTERLINE MI 48015

Officer/Director/Trustee Three

DEMETRIUS TINGLE
SECRETARY
22967 ALLEN RD
SAINT CLAIR SHORES MI 48080

Officer/Director/Trustee Four

TONYA SMITH
DIRECTOR
10730 MCKINNEY AVE
DETROIT MI 48224

Organization’s website
Organization’s email SHASTALS874@LIVE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/2020
Organization Incorporation State MI
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: 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SHASTA SMITH
Signature Title PRESIDENT
Signature Date 9/3/2020

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