FORM 1023-EZ for SAFE HARBOR HOMELESS SHELTER INC

Field Data
EIN 27-3578075
Case Number EO-2015040-000193
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAFE HARBOR HOMELESS SHELTER INC
Organization’s Mailing Address PO BOX 484
City REEDSBURG
State WI
ZIP 53959
Accounting period End 12
Primary contact name WILLIAM PETERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DARCY SWISCZ
PRESIDENT
S1265 B
LA VALLE WI 53941

Officer/Director/Trustee Two

ANITA MCKNIGHT
SECRETARY
733 N PARK
REEDSBURG WI 53959

Officer/Director/Trustee Three

WILLIAM PETERSON
OFFICER
E2401 BLACKFOREST DR
LA VALLE WI 53941

Officer/Director/Trustee Four

ZACHARY LANDON
DIRECTOR
1843 TIVOLI CO
REEDSBURG WI 53959

Officer/Director/Trustee Five

LORI PORTER
DIRECTOR
727 MYRTLE
REEDSBURG WI 53959

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2010
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P85 - Homeless Persons Centers, Services
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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