FORM 1023-EZ for ANDREWS HOUSE

Field Data
EIN 82-2101460
Case Number EO-2017193-000341
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ANDREWS HOUSE
Organization’s Mailing Address PO BOX 901
City SALEM
State IL
ZIP 62881
Accounting period End 12
Primary contact name JUSTIN I MATTHEWS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN MATTHEWS
PRESIDENT
521 MEADOWBROOK LN
CENTRALIA IL 62801

Officer/Director/Trustee Two

HAROLD THROCKMARTIN
VICE-PRESIDENT
2324 CHASE ST
TERRE HAUTE IN 47807

Officer/Director/Trustee Three

STANLEY C MATTHEWS
SECRETARY/TREASURER
1006 E POPLAR
ODIN IL 62870

Organization’s website
Organization’s email ANDREWSHOUSE.JUSTIN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/10/2017
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 Yes
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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