FORM 1023-EZ for PREGNANCY AFTER LOSS SUPPORT

Field Data
EIN 82-1106646
Case Number EO-2017150-000413
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PREGNANCY AFTER LOSS SUPPORT
Organization’s Mailing Address 5201 OVERLOOK DR
City BLOOMINGTON
State MN
ZIP 55437
Accounting period End 12
Primary contact name LINDSEY HENKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LINDSEY HENKE
CHAIR
5201 OVERLOOK DR
BLOOMINGTON MN 55437

Officer/Director/Trustee Two

LA TOYA COOPER
SECRETARY
668 COALFIRE AVENUE
HUEYTOWN AL 35023

Officer/Director/Trustee Three

SHAUNA ITRI
BOARD MEMBER
200 CHRISTIAN ST NO 24
PHILADELPHIA PA 19147

Officer/Director/Trustee Four

BEVIN KEENE
BOARD MEMBER
4408 PEBBLE BEACH CIRCLE
BESSEMER AL 35022

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/19/2017
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
Organization’s purpose Charitable: Yes
Religious: No
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 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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