FORM 1023-EZ for HOMECARE ADVOCACY NETWORK SUPPORT FUND INC

Field Data
EIN 85-3570597
Case Number EO-2021064-002302
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HOMECARE ADVOCACY NETWORK SUPPORT FUND INC
Organization’s Mailing Address 3610 NORTH 163RD PLAZA
City OMAHA
State NE
ZIP 68116
Accounting period End 12
Primary contact name MARK GOETZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARK GOETZ
DIRECTOR / PRESIDENT
3610 NORTH 163RD PLAZA
OMAHA NE 68116

Officer/Director/Trustee Two

HOLLY GILLESPIE
DIRECTOR / VICE-PRESIDENT
1228 N 164TH STREET
OMAHA NE 68118

Officer/Director/Trustee Three

MIKE FRANK
DIRECTOR / TREASURER
15611 BURT STREET
OMAHA NE 68118

Officer/Director/Trustee Four

JOY DOLL
DIRECTOR
116 N 38TH AVE
OMAHA NE 68131

Officer/Director/Trustee Five

SIERRA GOETZ
SECRETARY
3610 NORTH 163RD PLAZA
OMAHA NE 68116

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/21/2020
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 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 MARK GOETZ
Signature Title DIRECTOR / PRESIDENT
Signature Date 1/15/2021

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