FORM 1023-EZ for HIGHER GROUND REFUGE INC

Field Data
EIN 47-3313512
Case Number EO-2015267-000236
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HIGHER GROUND REFUGE INC
Organization’s Mailing Address 6112 W 26TH ST
City CICERO
State IL
ZIP 60804-3001
Accounting period End 6
Primary contact name NINA LOPEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NINA LOPEZ
PRESIDENT
6046 W PERSHING RD APT 7
CICERO IL 60804-3001

Officer/Director/Trustee Two

EDDIE LOPEZ
DIRECTOR
6112 W 26TH ST
CICERO IL 60804-3001

Officer/Director/Trustee Three

ANA MACARIO
SECRETARY
5139 W 23RD ST
CICERO IL 60804-3001

Officer/Director/Trustee Four

JUAN MOJICA
DIRECTOR
1528 S AUSTIN BLVD
CICERO IL 60804-3001

Officer/Director/Trustee Five

OPHELIA VALLADARES
DIRECTOR
1528 S AUSTIN BLVD
CICERO IL 60804-3001

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/22/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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
Signature Title
Signature Date

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