FORM 1023-EZ for BROOKHAVEN HAMLET FOUNDATION INC

Field Data
EIN 81-1760963
Case Number EO-2016118-000269
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BROOKHAVEN HAMLET FOUNDATION INC
Organization’s Mailing Address PO BOX 387
City BROOKHAVEN
State NY
ZIP 11719
Accounting period End 12
Primary contact name JANET QUIRK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JEFFREY JENSEN
PRESIDENT
PO BOX 387
BROOKHAVEN NY 11719

Officer/Director/Trustee Two

JOHN KNAPP
VICE PRESIDENT
PO BOX 387
BROOKHAVEN NY 11719

Officer/Director/Trustee Three

ELLEN CLYNE
SECRETARY
PO BOX 387
BROOKHAVEN NY 11719

Officer/Director/Trustee Four

JANET QUIRK
TREASURER
PO BOX 387
BROOKHAVEN NY 11719

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/2/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 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
Signature Title
Signature Date

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