FORM 1023-EZ for SAFE HAVEN MINISTRIES

Field Data
EIN 81-0841540
Case Number EO-2015357-000162
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAFE HAVEN MINISTRIES
Organization’s Mailing Address 1017 CO RD 2015 E
City FAIRFIELD
State IL
ZIP 62837
Accounting period End 12
Primary contact name JAY H FYIE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MELISSA GARRISON
PRESIDENT/DIRECTOR
1017 CO RD E
FAIRFIELD IL 62837

Officer/Director/Trustee Two

MARGE SIMPSON
SECRETARY/DIRECTOR
304 WHITESIDE LANE
FAIRFIELD IL 62837

Officer/Director/Trustee Three

KATHY SUTTON
DIRECTOR
705 NORTH FIRST ST
FAIRFIELD IL 62837

Officer/Director/Trustee Four

DIMITRI MONGE
TREASURER/DIRECTOR
1416 LEININGER ROAD
FAIRFIELD IL 62837

Officer/Director/Trustee Five

MARK ODLE
DIRECTOR
400 NE 4TH ST
FAIRFIELD IL 62837

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/3/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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 Yes
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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