FORM 1023-EZ for CONSCIENCE HOUSE CORPORATION

Field Data
EIN 61-1677205
Case Number EO-2016231-000244
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CONSCIENCE HOUSE CORPORATION
Organization’s Mailing Address 22710 BLACKBBURN
City SAINT CLAIR SHORES
State MI
ZIP 48080
Accounting period End 12
Primary contact name WAYNE P LISAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WAYNE P LISAK
PRESIDENT
22710 BLACKBURN
ST. CLAIR SHORES MI 48080

Officer/Director/Trustee Two

TODD ELLIOTT
VICE PRESIDENT
302 W RIDGE RD
ST. CLAIR SHORES MI 48867

Officer/Director/Trustee Three

WAYNE LISAK II
SECOUND VICE PRESIDENT
22710 BLACKBURN
ST. CLAIR SHORES MI 48080

Officer/Director/Trustee Four

CHAD LISAK
DIRECTOR/SECRETARY
22710 BLACKBURN
CLINTON TOWNSHIP MI 48038

Officer/Director/Trustee Five

GAVEN PORTER
TRUSTEE
1516 YORKSHIRE
HOWELL MI 48843

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/11/2011
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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