FORM 1023-EZ for SOUTH HAVEN SENIOR CENTER INC

Field Data
EIN 46-0637945
Case Number EO-2015231-000242
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTH HAVEN SENIOR CENTER INC
Organization’s Mailing Address 220 SOUTH MAIN STREET
City SOUTH HAVEN
State KS
ZIP 67140
Accounting period End 12
Primary contact name ERNEST BURKHART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ERNEST BURKHART
PRESIDENT
PO BOX 70
BRAMAN OK 74632

Officer/Director/Trustee Two

VERNON HROMAS
SECRETARY
207 S CARDINAL
SOUTH HAVEN KS 67140

Officer/Director/Trustee Three

DOROTHY DVORAK
TREAS
501 WEST STUART ST
SOUTH HAVEN KS 67140

Officer/Director/Trustee Four

HAZEL RATZLAFF
DIRECTOR
107 N WICHITA
SOUTH HAVEN KS 67140

Officer/Director/Trustee Five

CARL JONES
DIRECTOR
209 E CLYDE
SOUTH HAVEN KS 67140

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/27/2012
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P81 - Senior Centers, 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
Signature Title
Signature Date

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