FORM 1023-EZ for HUMAN HEALTH INITIATIVE

Field Data
EIN 82-1130256
Case Number EO-2017220-000208
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HUMAN HEALTH INITIATIVE
Organization’s Mailing Address 77529 WESTBROOK COURT
City PALM DESERT
State CA
ZIP 92211
Accounting period End 12
Primary contact name JASON TATE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JASON TATE
PRESIDENT
77529 WESTBROOK CT
PALM DESERT CA 92211

Officer/Director/Trustee Two

ROBERT HETTINGER
TREASURER
2005 E TACHEVAH DR
PALM SPRINGS CA 92262

Officer/Director/Trustee Three

JILAYNE LOVEJOY
SECRETARY
28652 ABANTES PLACE
LAGUNA NIGUEL CA 92677

Officer/Director/Trustee Four

BRUCE BOISVERT
BOARD MEMBER CONTRIBUTOR
72671 THEODORA LANE
PALM DESERT CA 92260

Officer/Director/Trustee Five

ERIC COREY-FREED
BOARD MEMBER
3236 SE CLINTON STREET
PORTLAND OR 92677

Organization’s website WWW.HUMANHEALTHINITIATIVE.ORG
Organization’s email JASON@HUMANHEALTHINITIATIVE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/5/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: No
Religious: No
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 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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