FORM 1023-EZ for THE PILOT HOUSE OF INDIANA INC

Field Data
EIN 82-3973004
Case Number EO-2018031-000148
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE PILOT HOUSE OF INDIANA INC
Organization’s Mailing Address 411 CAMDEN STREET
City SOUTH BEND
State IN
ZIP 46619
Accounting period End 12
Primary contact name ROBERT HENDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT HENDERSON
PRESIDENT/DIRECTOR
411 CAMDEN
SOUTH BEND IN 46619

Officer/Director/Trustee Two

GREGORY SMITH
DIRECTOR
411 CAMDEN
SOUTH BEND IN 46619

Officer/Director/Trustee Three

MICHAEL THOMPSON
DIRECTOR
411 CAMDEN
SOUTH BEND IN 46619

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/6/96
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 No
Donation of funds Yes
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 Yes
Correctness Declaration Yes
Signature Name ROBERT HENDERSON
Signature Title PRESIDENT/DIRECTOR
Signature Date 1/29/18

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