FORM 1023-EZ for AUTOIMMUNE HEALTH REVOLUTION INC

Field Data
EIN 82-3843620
Case Number EO-2018008-000112
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AUTOIMMUNE HEALTH REVOLUTION INC
Organization’s Mailing Address 15 CRESCENT RIDGE ROAD
City BOONTON
State NJ
ZIP 7005
Accounting period End 6
Primary contact name MICHAEL OTTEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENISE OTTEN
PRESIDENT
15 CRESCENT RIDGE ROAD
BOONTON NJ 7005

Officer/Director/Trustee Two

RAYMOND HYER
VICE PRESIDENT
925 GLADESTRY LANE
LOWER GWYNEDD PA 19002

Officer/Director/Trustee Three

MONICA COLON
SECRETARY
300 PELHAM ROAD APT 4K
NEW ROCHELLE NY 10805

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/28/17
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion 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 Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DENISE OTTEN
Signature Title PRESIDENT
Signature Date 1/4/18

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