FORM 1023-EZ for HALLOWED HAVEN 131815 INC

Field Data
EIN 83-2440733
Case Number EO-2018323-000519
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HALLOWED HAVEN 131815 INC
Organization’s Mailing Address 51387 US HWY 50 1 EARL AVE SUITE B
City PARLIN
State CO
ZIP 81239
Accounting period End 12
Primary contact name DIANE BRAZINSKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DIANE BRAZINSKY
PRESIDENT & CEO
PO BOX 165
PARLIN CO 81239

Officer/Director/Trustee Two

BECKY DARNELL
CHIEF FINANCIAL OFFICER
1000 N MAIN STREET STE 1
GUNNISON CO 81230

Officer/Director/Trustee Three

FRANCINE CUCCARO
CHIEF OPERATING OFFICER
418 S 12TH STREET
GUNNISON CO 81230

Officer/Director/Trustee Four

SEAN MCGLINCEY
VICE PRESIDENT
487 COUNTY RD 24 UU
GUNNISON CO 81230

Officer/Director/Trustee Five

JULIE HATFIELD
DIRECTOR OF ADMISSIONS
1313 W OHIO 7
GUNNISON CO 81230

Organization’s website
Organization’s email DBRAZINSKY1577@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/18
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
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 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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DIANE BRAZINSKY
Signature Title PRESIDENT & CEO
Signature Date 11/16/18

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