FORM 1023-EZ for HEALTH AND SAFETY EDUCATION SERVICECORP

Field Data
EIN 86-3639448
Case Number EO-2021126-000359
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTH AND SAFETY EDUCATION SERVICECORP
Organization’s Mailing Address PO BOX 3242
City CUMMING
State GA
ZIP 30028
Accounting period End 12
Primary contact name DERIC WINSLETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DERIC WINSLETT
DIRECTOR
3420 HYACINTH WAY
CUMMING GA 30041

Officer/Director/Trustee Two

JEAN ARRINGTON
OFFICER
PO BOX 2468
LAGRANGE GA 30230

Officer/Director/Trustee Three

JONATHAN KIPPEN
OFFICER
6640 COUNTY FARM RD
CROSWELL MI 48422

Organization’s website
Organization’s email HSESCORP@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/21/2021
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M40 - Safety Education
Organization’s purpose Charitable: Yes
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 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 DERIC WINSLETT
Signature Title DIRECTOR
Signature Date 5/4/2021

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