FORM 1023-EZ for HAITIAN-AMERICAN COMMUNITY ALLIANCEINC

Field Data
EIN 81-5029455
Case Number EO-2017156-000079
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HAITIAN-AMERICAN COMMUNITY ALLIANCEINC
Organization’s Mailing Address 1010 BARNET RD SUITE A
City COLUMBUS
State OH
ZIP 43227
Accounting period End 12
Primary contact name REYNOLD NELSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REYNOLD NELSON
PRESIDENT
5903 LITLE BROOK WAY
COLUMBUS OH 43232

Officer/Director/Trustee Two

YRVENS PIERRE
TREASURER
3077 KINGS REALM AVENUE
COLUMBUS OH 43232

Officer/Director/Trustee Three

JEAN RUMBOLD
SECRETARY
7401 BENTLEY STATION PL
REYNOLDSBURG OH 43068

Organization’s website WWW.HACAOH.ORG
Organization’s email HACALLIANCE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/9/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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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