FORM 1023-EZ for HAYDENS HOUSE OF HEALING

Field Data
EIN 81-4141079
Case Number EO-2018140-000058
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HAYDENS HOUSE OF HEALING
Organization’s Mailing Address 118 BATHURST AVE
City NORTH ARLINGTON
State NJ
ZIP 7031-5926
Accounting period End 12
Primary contact name ROBERT DORSETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ADY DORSETT
CEO
118 BATHURST AVE
NORTH ARLINGOTN NJ 7031-5926

Officer/Director/Trustee Two

ROBERT DORSETT
TRUSTEE
118 BATHURST AVE
NORTH ARLINGTON NJ 7031-5926

Officer/Director/Trustee Three

STACEY WILLIAMS
TRUSTEE
306 ROOSEVELT AVE
MILMONT PARK PA 19033-3131

Officer/Director/Trustee Four

AMANDA BOUNGNASIRI
TRUSTEE
3366 KATHY WAY
LOOMIS CA 95650-8764

Officer/Director/Trustee Five

ROBERT SMITH
TRUSTEE
1825 MARSHALL AVE
WILLIAMSPORT PA 17701-1075

Organization’s website WWW.HAYDENSHOUSE.ORG
Organization’s email ADY.DORSETT@HAYDENSHEART.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/16
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
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 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 ROBERT DORSETT
Signature Title TRUSTEE
Signature Date 5/15/18

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