FORM 1023-EZ for HAITI KONBAT MALADI INC

Field Data
EIN 83-1445949
Case Number EO-2019036-000335
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HAITI KONBAT MALADI INC
Organization’s Mailing Address 2308 FIVE OAKS WAY
City TUCKER
State GA
ZIP 30084
Accounting period End 12
Primary contact name GHERIANE ULYSSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GHERIANE ULYSSE
CO- EXECUTIVE DIRECTOR
PO BOX 4257
SUWANEE GA 30024

Officer/Director/Trustee Two

DOMINIQUE GUILLAUME
CO-EXECUTIVE DIRECTOR
2308 FIVE OAKS WAY
TUCKER GA 30084

Officer/Director/Trustee Three

JEAN-LUC ROLLAND
BOARD CHAIRPERSON
2308 FIVE OAKS WAY
TUCKER GA 30084

Officer/Director/Trustee Four

LAURA PIERRE
TREASURER
2308 FIVE OAKS WAY
TUCKER GA 30084

Officer/Director/Trustee Five

LAETIA AMEDEE
SECRETARY
2308 FIVE OAKS WAY
TUCKER GA 30084

Organization’s website
Organization’s email GHERIANEULYSSE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/27/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
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 Yes
Donation of funds No
Conducting Activities Outside of United States Yes
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 GHERIANE ULYSSE
Signature Title CO- EXECUTIVE DIRECTOR
Signature Date 1/16/19

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