FORM 1023-EZ for HAVEN OF HOPE LASERTOMA INC

Field Data
EIN 37-1851294
Case Number EO-2017072-000470
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HAVEN OF HOPE LASERTOMA INC
Organization’s Mailing Address 7500 OLD ROXBURY RD
City QUINTON
State VA
ZIP 23141
Accounting period End 1
Primary contact name JOANNE SIMMONS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOANNE SIMMONS
PRESIDENT
7500 OLD ROXBURY RD
QUINTON VA 23141

Officer/Director/Trustee Two

HELENA JONES
TREASURER
5610 GOLDEN WHEEL RD
PROVIDENCE FORGE VA 23140

Officer/Director/Trustee Three

ELIZABETH DONOVAN
SECRETARY
6219 LAKESIDE DRIVE
QUINTON VA 23141

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/21/2017
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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
Signature Title
Signature Date

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