FORM 1023-EZ for HUMAN HEALTH AND WELLNESS INNOVATION INSTITUTE

Field Data
EIN 83-2249446
Case Number EO-2021064-001230
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HUMAN HEALTH AND WELLNESS INNOVATION INSTITUTE
Organization’s Mailing Address 9048 HERRING COVE AVE
City LAS VEGAS
State NV
ZIP 89178
Accounting period End 12
Primary contact name COUNTESS COURTNEY-LEE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

COUNTESS COURTNEY-LEE
PRESIDENT
9048 HERRING COVE AVE
LAS VEGAS NV 89178-6269

Officer/Director/Trustee Two

ANTHONY KHOTSIKIAN
VICE PRESIDENT
2901 DESERT ZINNIA LANE
LAS VEGAS NV 89135-2052

Officer/Director/Trustee Three

MADDISON GULLI
DIRECTOR
730 OAKMONT AVE UNIT 909
LAS VEGAS NV 89109-0109

Officer/Director/Trustee Four

BROOK COOK
SECRETARY
5700 VILLAGE OAKS DRIVE UNIT 3217
SAN JOSE CA 95123-3769

Officer/Director/Trustee Five

KEN TAM
TREASURER
9048 HERRING COVE AVE
LAS VEGAS NV 89178-6269

Organization’s website WWW.HHAWII.ORG
Organization’s email THECOUNTESSCOURTNEY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/20/2019
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H90 - Medical Specialty Research
Organization’s purpose Charitable: No
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 Yes
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 COUNTESS COURTNEY-LEE
Signature Title PRESIDENT
Signature Date 1/11/2021

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