FORM 1023-EZ for HEAVENS PRECIOUS MOMENT INC

Field Data
EIN 86-3149283
Case Number EO-2021104-000455
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEAVENS PRECIOUS MOMENT INC
Organization’s Mailing Address 519 S 1ST ST
City LA CRESCENT
State MN
ZIP 55947
Accounting period End 12
Primary contact name DAPHANE GRISAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAPHANE GRISAR
OFFICER
519 S 1ST ST
LA CRESCENT MN 55947

Officer/Director/Trustee Two

KATHY SEVERSON
OFFICER
727 N 4TH ST
LA CRESCENT MN 55947

Officer/Director/Trustee Three

HANNAH KIDD
BOARD MEMBER
410 SOUTH RAMSEY ST APT 4
CALEDONIA MN 55921

Officer/Director/Trustee Four

MELLONY THESING
BOARD MEMBER
N911 SKEMP ROAD
LA CROSSE WI 54601

Officer/Director/Trustee Five

ANGELA WOLTER MEYER
BOARD MEMBER
9412 STATE 26
BROWNSVILLE MN 55919

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/7/2021
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name DAPHANE GRISAR
Signature Title OFFICER
Signature Date 4/9/2021

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