FORM 1023-EZ for HOPE HAVEN BEHAVIORAL HEALTH INC

Field Data
EIN 84-4337178
Case Number EO-2020021-000576
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HOPE HAVEN BEHAVIORAL HEALTH INC
Organization’s Mailing Address 3100 UNIVERSITY BLVD SOUTH STE 218
City JACKSONVILLE
State FL
ZIP 32216
Accounting period End 12
Primary contact name TOYE BRADFORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TOYE BRADFORD
CEO
307 SAINT JAMES WAY
ORANGE PARK FL

Officer/Director/Trustee Two

FRED WILSON
BOARD MEMBER
623 BEECHWOOD STREET
JACKSONVILLE FL 32206

Officer/Director/Trustee Three

NICOLE WATSON
TREASURER
2408 SOUTEL DRIVE
JACKSONVILLE FL 32208

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2019
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E50 - Rehabilitative Medical 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 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 TOYE BRADFORD
Signature Title CEO
Signature Date 1/17/2020

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