FORM 1023-EZ for HEAL PAVILION - HEALTH EDUCATION FOR AN AMAZING LIFESTYLE

Field Data
EIN 82-1850414
Case Number EO-2017317-000626
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEAL PAVILION - HEALTH EDUCATION FOR AN AMAZING LIFESTYLE
Organization’s Mailing Address P O BOX 1565
City HAMMOND
State LA
ZIP 70404
Accounting period End 12
Primary contact name DINAH CARTER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DINAH CARTER
DIRECTOR
PO BOX 1565
HAMMOND LA 70404

Officer/Director/Trustee Two

TOYA TILLMAN
SECRETARY
42327 JEROME DRIVE
HAMMOND LA 70401

Officer/Director/Trustee Three

RICHARD HARBOR
TREASURER
13618 KEITH ST
WALKER LA 70785

Organization’s website
Organization’s email FPMBAPR@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/11/2017
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
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
Signature Title
Signature Date

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