FORM 1023-EZ for DAVONNA HOMES FOR HOSPICE AND PALLIATIVE CARE

Field Data
EIN 81-4537489
Case Number EO-2017009-000565
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DAVONNA HOMES FOR HOSPICE AND PALLIATIVE CARE
Organization’s Mailing Address 85 CILLEYVILLE ROAD
City ANDOVER
State NH
ZIP 03216
Accounting period End 12
Primary contact name DAVID BATES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DONNA POURBY
CO-PRESIDENT
85 CILLEYVILLE ROAD
ANDOVER NH 03216

Officer/Director/Trustee Two

DAVID BATES
CO-PRESIDENT
85 CILLEYVILLE ROAD
ANDOVER NH 03216

Officer/Director/Trustee Three

TIM BOYNTON
VICE PRESIDENT
1112 CLEARPOINT WAY
LAKEKLAND FL 33813

Officer/Director/Trustee Four

SANDY MESSER
TREASURER
PO BOX 733
NEW LONDON NH 03257

Officer/Director/Trustee Five

KENT ARMSTRONG
SECRETARY
284 DEPOT STREET
ANDOVER NH 03216

Organization’s website DAVONNAHOMES.ORG
Organization’s email DAVONNAHOMES@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/28/2016
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P74 - Hospice
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
Signature Title
Signature Date

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