FORM 1023-EZ for HIS PROVISION INC

Field Data
EIN 84-1311328
Case Number EO-2015316-000291
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HIS PROVISION INC
Organization’s Mailing Address 705 ULYSSES ST
City GOLDEN
State CO
ZIP 80401
Accounting period End 12
Primary contact name REBECCA WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EROSTUS C WHITE
PRESIDENT
635 JOYCE ST
GOLDEN CO 80401-4027

Officer/Director/Trustee Two

PATRICIA RAMSTETTER
VICE PRES
16570 W 12TH PL
GOLDEN CO 80401

Officer/Director/Trustee Three

REBECCA WHITE
SEC/TREAS
635 JOYCE ST
80401 CO 80401

Organization’s website
Organization’s email REBECCA_WHITE@COMCAST.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/1995
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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