FORM 1023-EZ for TRAUMA HAVEN

Field Data
EIN 85-2842006
Case Number EO-2020252-000528
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TRAUMA HAVEN
Organization’s Mailing Address 438 9TH AVE UNIT B
City FORT KNOX
State KY
ZIP 40121
Accounting period End 12
Primary contact name DENISE R LONG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENISE LONG
DIRECTOR
438 9TH AVE UNIT B
FORT KNOX KY 40121

Officer/Director/Trustee Two

DEVONNIA NAYLOR
DIRECTOR
438 9TH AVE UNIT B
FORT KNOX KY 40121

Officer/Director/Trustee Three

ERICA LONG
DIRECTOR
438 9TH AVE UNIT B
FORT KNOX KY 40121

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/15/2020
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
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 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 DENISE LONG
Signature Title DIRECTOR
Signature Date 9/3/2020

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