FORM 1023-EZ for HIS1ORG INC

Field Data
EIN 84-4106130
Case Number EO-2020013-000164
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HIS1ORG INC
Organization’s Mailing Address 257 PINTAIL RUN LN
City MOORESVILLE
State NC
ZIP 28117
Accounting period End 12
Primary contact name JEFFREY P RALYEA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TONYA RALYEA
CHAIRMAN
257 PINTAIL RUN LN
MOORESVILLE NC 28117

Officer/Director/Trustee Two

JEFFREY RALYEA
PRESIDENT
257 PINTAIL RUN LN
MOORESVILLE NC 28117

Officer/Director/Trustee Three

KAREN STAINBROOK
SECRETARY
5555 MEDALLION DR W
WESTERVILLE OH 43082

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/19/2019
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JEFFREY RALYEA
Signature Title PRESIDENT
Signature Date 1/9/2020

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