FORM 1023-EZ for SHS NH 501C3 INC

Field Data
EIN 83-4428455
Case Number EO-2019108-000254
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHS NH 501C3 INC
Organization’s Mailing Address 360 RT 101 STE 3B
City BEDFORD
State NH
ZIP 3110
Accounting period End 12
Primary contact name RANDAL LOUBIER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RANDAL LOUBIER
DIRECTOR
360 RT 101 STE 3B
BEDFORD NH 3110

Officer/Director/Trustee Two

JUDITH LOUBIER
DIRECTOR
360 ROUTE 101 STE 3B
BEDFORD NH 3110

Officer/Director/Trustee Three

MITCHELL ILACQUA
DIRECTOR
360 ROUTE 101 STE 3B
BEDFORD NH 3110

Officer/Director/Trustee Four

DANIEL ILACQUA
DIRECTOR
360 ROUTE 101 STE 3B
BEDFORD NH 3110

Officer/Director/Trustee Five

VICTORIA CALLAHAN
DIRECTOR
360 RT 101 STE 3B
BEDFORD NH 3110

Organization’s website WWW.SHS-NH.COM/NONPROFIT
Organization’s email RANDY@SHS-NH.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/16/19
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E92 - Home Health Care
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 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 RANDAL LOUBIER
Signature Title DIRECTOR
Signature Date 4/16/19

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