FORM 1023-EZ for HOLE IN ONE ANIMAL RESCUE INC

Field Data
EIN 47-1455570
Case Number EO-2017073-000170
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOLE IN ONE ANIMAL RESCUE INC
Organization’s Mailing Address 592 ELM ST
City WINDSOR LOCKS
State CT
ZIP 06096
Accounting period End 12
Primary contact name ALEXA BRENGI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALEXA BRENGI
DIRECTOR
32 S CENTER ST
WINDSOR LOCKS CT 06096

Officer/Director/Trustee Two

MARK BRENGI
VICE PRESIDENT
32 S CENTER ST
WINDSOR LOCKS CT 06096

Officer/Director/Trustee Three

STEPHANIE KOSTIUK
TREASURER
12 ASH DR
WINDSOR LOCKS CT 06096

Officer/Director/Trustee Four

MICHAEL KOSTIUK
SECRETARY
12 ASH DR
WINDSOR LOCKS CT 06096

Officer/Director/Trustee Five

MICHAEL SUGALSKI
CHAIRPERSON
34 S CENTER ST
WINDSOR LOCKS CT 06096

Organization’s website HOLEINONEANIMALRESCUE.COM
Organization’s email HOLEINONEANIMALRESCUE@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/29/2014
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D00 -
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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