FORM 1023-EZ for ELIZABETH HOME OF PONTIAC ILLINOIS

Field Data
EIN 81-3186995
Case Number EO-2016343-000328
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ELIZABETH HOME OF PONTIAC ILLINOIS
Organization’s Mailing Address PO BOX 442
City PONTIAC
State IL
ZIP 61764
Accounting period End 12
Primary contact name CURTIS MYERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY BAKER
DIRECTOR
14914 E 1200 N RD
PONTIAC IL 61764

Officer/Director/Trustee Two

DARLETA GRAMM
DIRECTOR
26118 N 2225 E RD
LEXINGTON IL 61753

Officer/Director/Trustee Three

CURTIS MYERS
DIRECTOR
304 S MILL ST
PONTIAC IL 61764

Officer/Director/Trustee Four

WAYNE NELSON
DIRECTOR
213 W CHESTNUT ST
FAIRBURY IL 61739

Officer/Director/Trustee Five

LYNN STOLLER
DIRECTOR
10897 N 200 E RD
GRIDLEY IL 61744

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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
Signature Title
Signature Date

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