FORM 1023-EZ for GERNIES PLACE COMMUNITY HOUSE

Field Data
EIN 46-3221064
Case Number EO-2014266-000128
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GERNIES PLACE COMMUNITY HOUSE
Organization’s Mailing Address 8300 SEA STAR DR
City BLACKLICK
State OH
ZIP 43004
Accounting period End 12
Primary contact name MICHAEL A HAAS EA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NINA BARKSDALE
PRESIDENT
8300 SEA STAR DR
BLACKLICK OH 43004

Officer/Director/Trustee Two

AUBRE JONES
VICE PRESIDENT
1395 MILLERDALE RD
COLUMBUS OH 43209

Officer/Director/Trustee Three

ANDREA JONES
SECRETARY
2732 SONATA DR
COLUMBUS OH 43209

Officer/Director/Trustee Four

WINFORD DEARING
TREASURER
237 LANSDOWNE AVE
GAHANNA OH 43230

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/2013
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 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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