FORM 1023-EZ for ASSISI HOUSE INC

Field Data
EIN 81-1117609
Case Number EO-2016068-000248
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ASSISI HOUSE INC
Organization’s Mailing Address 9936 E CARMEL COURT
City BATON ROUGE
State LA
ZIP 70818-3115
Accounting period End 12
Primary contact name LESLIE T GROVER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LESLIE GROVER
PRESIDENT/FOUNDER/CHAIR
9936 E CARMEL CT
BATON ROUGE LA 70818-3115

Officer/Director/Trustee Two

REVATHI HINES
VICE PRESIDENT
500 JESSE STONE HIGGINS HALL 4TH FL
BATON ROUGE LA 70813-0001

Officer/Director/Trustee Three

MILTON BRADLEY
SECRETARY
311 RIVERCREST AVE
BATON ROUGE LA 70807-2546

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/10/2016
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L80 - Housing Support Services -- Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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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