FORM 1023-EZ for PEACEFUL LIVING HEALTH ASSOCIATION

Field Data
EIN 46-4001227
Case Number EO-2014293-000102
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEACEFUL LIVING HEALTH ASSOCIATION
Organization’s Mailing Address 411 COUNTY ROAD UU SUITE 3
City HUDSON
State WI
ZIP 54016
Accounting period End 12
Primary contact name IRENE PREGL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

IRENE PREGL
CHAIRPERSON
213 RIVERCREST DR
HUDSON WI 54016

Officer/Director/Trustee Two

HELEN PREGL
SECRETARY
4991 PERKINSVILLE ROAD
MAPLE PLAIN MN 55359

Organization’s website
Organization’s email IRENE.PREGL@PEACEFULLIVINGCARE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/10/2013
Organization Incorporation State NC
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: 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 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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