FORM 1023-EZ for HAITIAN FAMILY MEDICAL RELIEF PROJECT INC

Field Data
EIN 46-5139295
Case Number EO-2016333-000196
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HAITIAN FAMILY MEDICAL RELIEF PROJECT INC
Organization’s Mailing Address 9425 TERMINAL AVE
City SKOKIE
State IL
ZIP 60077
Accounting period End 12
Primary contact name WIDNER REGIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WIDNER REGIS
PRESIDENT/FOUNDER
9425 TERMINAL AVE
SKOKIE IL 60077-1501

Officer/Director/Trustee Two

CARLINE CELESTE
TREASURER
1340 GENEVA DR
PALATINE IL 60074-3297

Officer/Director/Trustee Three

MARIE SOLANGE MORENCY
SECRETARY
1017 E 161 PL
SOUTH HOLLAND IL 60473-1772

Organization’s website WWW.HAITIANFAMILYRELIEF.ORG
Organization’s email WREGIS@HAITIANFAMILYRELIEF.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/28/2014
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: No
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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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