FORM 1023-EZ for NICKELIS SAFE HAVEN

Field Data
EIN 26-4744774
Case Number EO-2018109-000221
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NICKELIS SAFE HAVEN
Organization’s Mailing Address 9057 S PARNELL AVE
City CHICAGO
State IL
ZIP 60620-2240
Accounting period End 4
Primary contact name BRANDY GARNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRANDY GARNER
DIRECTOR/CEO
9057 S PARNELL
CHICAGO IL 60620-2240

Officer/Director/Trustee Two

LEONARD NANCE
TREASURER
9057 S PARNELL
CHICAGO IL 60620-2240

Officer/Director/Trustee Three

ADELLA GARNER
SECRETARY
6948 S DORCHESTER
CHICAGO IL 60637

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/15/12
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P85 - Homeless Persons Centers, 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 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 BRANDY GARNER
Signature Title DIRECTOR/CEO
Signature Date 4/13/18

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