FORM 1023-EZ for INTEGRATED HOME & COMMUNITY RECREATION THERAPY

Field Data
EIN 83-0868766
Case Number EO-2018295-000370
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INTEGRATED HOME & COMMUNITY RECREATION THERAPY
Organization’s Mailing Address 1810 TIMBER TRAIL
City ANN ARBOR
State MI
ZIP 48103
Accounting period End 12
Primary contact name DIANE WAGNER-HEFFNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DIANE WAGNER-HEFFNER
CHAIR
1810 TIMBER TRAIL
ANN ARBOR MI 48103

Officer/Director/Trustee Two

DAVID HEFFNER
VICE-CHAIR
1810 TIMBER TRAIL
ANN ARBOR MI 48103

Officer/Director/Trustee Three

SHAWN PREISSLE
DIRECTOR
1810 TIMBER TRAIL
ANN ARBOR MI 48103

Officer/Director/Trustee Four

JESSICA SPOONER
DIRECTOR
1810 TIMBER TRAIL
ANN ARBOR MI 48103

Officer/Director/Trustee Five

LAKSHMI SHETTY
DIRECTOR
1810 TIMBER TRAIL
ANN ARBOR MI 48103

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/28/18
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 Yes
Conducting Activities Outside of United States No
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DIANE WAGNER-HEFFNER
Signature Title CHAIR
Signature Date 10/19/18

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