FORM 1023-EZ for HOLLYS HAVEN FOR NATURAL CARE

Field Data
EIN 85-1800418
Case Number EO-2020192-000272
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HOLLYS HAVEN FOR NATURAL CARE
Organization’s Mailing Address 348 S WAVERLY RD
City HOLLAND
State MI
ZIP 49423
Accounting period End 12
Primary contact name ADAM ZUWERINK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CONNIE KELLY
PRESIDENT AND DIRECTOR
2564 SAWTOOTH CT
HOLLAND MI 49424

Officer/Director/Trustee Two

REBECCA LECLAIRE
DIRECTOR
6079 126TH AVE
FENNVILLE MI 49408

Officer/Director/Trustee Three

JULIE PANGBORN
DIRECTOR
124 FAWN DR
WHITEMORE LAKE MI 48189

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/7/2020
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 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 CONNIE KELLY
Signature Title PRESIDENT AND DIRECTOR
Signature Date 7/8/2020

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