FORM 1023-EZ for HISSTORY HAVEN

Field Data
EIN 84-4290008
Case Number EO-2020022-000394
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HISSTORY HAVEN
Organization’s Mailing Address 220 FOOTHILLS SOUTH DRIVE
City SEDONA
State AZ
ZIP 86336
Accounting period End 12
Primary contact name LORAINE COUTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORAINE COUTIN
PRESIDENT, DIRECTOR
220 FOOTHILLS SOUTH DRIVE
SEDONA AZ 86336

Officer/Director/Trustee Two

SAVAS SOSANGELIS
DIRECTOR
220 FOOTHILLS SOUTH DRIVE
SEDONA AZ 86336

Officer/Director/Trustee Three

MICHELE FOSTER
DIRECTOR
220 FOOTHILLS SOUTH DRIVE
SEDONA AZ 86336

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/9/2020
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LORAINE COUTIN
Signature Title PRESIDENT, DIRECTOR
Signature Date 1/20/2020

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