FORM 1023-EZ for HEAVENLY CARE HOMELESS SUPPORT INC

Field Data
EIN 84-3548472
Case Number EO-2019339-000288
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEAVENLY CARE HOMELESS SUPPORT INC
Organization’s Mailing Address 121 HICKORY STREET
City VALLEJO
State CA
ZIP 94589
Accounting period End 12
Primary contact name PATRICIA WHEELER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICIA WHEELER
PRESIDENT AND CEO
121 HICKORY STREET
VALLEJO CA 94589

Officer/Director/Trustee Two

SHARON PHIFER-BURNS
TREASURER
1525 SOLITUDE LN
RICHMOND CA 94803

Officer/Director/Trustee Three

KIMBERLY MOSES
SECRETARY AND DIRECTOR
22781 MOARE CT
HAYWARD CA 94589

Officer/Director/Trustee Four

NATHAN PAYNE
DIRECTOR
32607 ENDEAVOUR WAY
UNION CITY CA 94587

Officer/Director/Trustee Five

JACI PETERSON
DIRECTOR
8 HOWARD AVE
VALLEJO CA 94590

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/11/19
Organization Incorporation State CA
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: 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 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 PATRICIA WHEELER
Signature Title PRESIDENT AND CEO
Signature Date 12/3/19

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