FORM 1023-EZ for PALM BEACH COUNTY HAITIAN NURSES ASSOCIATION INC

Field Data
EIN 80-0821649
Case Number EO-2014317-000117
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PALM BEACH COUNTY HAITIAN NURSES ASSOCIATION INC
Organization’s Mailing Address 798 BLUEBERRY DRIVE
City WELLINGTON
State FL
ZIP 33414-8274
Accounting period End 12
Primary contact name TONIDE JEAN-MICHEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TONIDE JEAN-MICHEL
DIRECTOR AND PRESIDENT/CEO
798 BLUEBERRY DRIVE
WELLINGTON FL 33414-8274

Officer/Director/Trustee Two

MAND JEAN-MICCHEL
DIRECTOR AND TREASURER/CFO
798 BLUEBERRY DRIVE
WELLINGTON FL 33414-8274

Officer/Director/Trustee Three

KARLA BENJAMIN
DIRECTOR AND SECRETARY
2040 GREENVIEW SHORES BLVD
WELLINGTON FL 33414-2728

Organization’s website NONE
Organization’s email TONIDEORION@YAHOO.FR
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/9/2012
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q33 - International Relief
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 Yes
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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