FORM 1023-EZ for HEALING EYES INC

Field Data
EIN 47-2067260
Case Number EO-2014342-000220
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALING EYES INC
Organization’s Mailing Address 4630 EASTERN AVE SE APT 302
City GRAND RAPIDS
State MI
ZIP 49508-7572
Accounting period End 12
Primary contact name SARAH STACILAUSKAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SARAH STACILAUSKAS
DIRECTOR
6356 WEST CANTERBURY
BELMONT MI 49306

Officer/Director/Trustee Two

DONALD HENDRIKSEN
SECRETARY
4630 EASTERN AVE SE APT 302
GRAND RAPIDS MI 49508-7572

Officer/Director/Trustee Three

MIKE HOWARD
FUNDRAISING OFFICER
408 PEACH CT
WAYLAND MI 49348

Organization’s website WWW.HEALINGEYES.ORG
Organization’s email SSPACH@ALUMNI.NMU.EDU
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/30/2014
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q30 - International Development, Relief Services
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 No
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
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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