FORM 1023-EZ for HOUSE KHEPERU

Field Data
EIN 82-2616039
Case Number EO-2017242-000496
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOUSE KHEPERU
Organization’s Mailing Address PO BOX 1021
City MEDINA
State OH
ZIP 44258-1021
Accounting period End 12
Primary contact name ELYRIA LITTLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELLE BELANGER
PRESIDENT
PO BOX 1021
MEDINA OH 44258-1021

Officer/Director/Trustee Two

JASON CRUTCHFIELD
CHAIRPERSON
PO BOX 1021
MEDINA OH 44258-1021

Officer/Director/Trustee Three

AARON HAMMON
VICE CHAIRPERSON
PO BOX 1021
MEDINA OH 44258-1021

Officer/Director/Trustee Four

ELYRIA LITTLE
SECRETARY
PO BOX 1021
MEDINA OH 44258-1021

Officer/Director/Trustee Five

PAUL TRIMBLE
TREASURER
PO BOX 1021
MEDINA OH 44258-1021

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/2017
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X90 - Interfaith Issues
Organization’s purpose Charitable: No
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 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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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