FORM 1023-EZ for HAITIAN AMERICAN HUMAN SERVICES INC

Field Data
EIN 83-4349320
Case Number EO-2020196-000525
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HAITIAN AMERICAN HUMAN SERVICES INC
Organization’s Mailing Address 1601 CELLENY CT
City KISSIMMEE
State FL
ZIP 34744
Accounting period End 12
Primary contact name SUZY M SALOMON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUZETTE M AUXILLA
V
1601 CELLENY CT
KISSIMMEE FL 34744

Officer/Director/Trustee Two

SUZY M SALOMON
VP
1601 CELLENY CT
KISSIMMEE FL 34744

Officer/Director/Trustee Three

JEAN F AUXILA
DIRECTOR
1601 CELLENY CT
KISSIMMEE FL 34744

Organization’s website
Organization’s email SUE.MYFIRSTCARECLINIC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/22/2018
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
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 JEAN F AUXILA
Signature Title DIRECTOR
Signature Date 6/12/2020

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