FORM 1023-EZ for HAITI CLEAN WATER INC

Field Data
EIN 84-2976577
Case Number EO-2019266-000501
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HAITI CLEAN WATER INC
Organization’s Mailing Address 407 MAPLEBROOKE LN
City CADILLAC
State MI
ZIP 49601
Accounting period End 12
Primary contact name MICHAEL SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN JOYCE
DIRECTOR
243 N PINE ST
EVART MI 49631

Officer/Director/Trustee Two

RAPLH BROWN
DIRECTOR
2041 S 7-1/2 RD
HARRIETTA MI 49638

Officer/Director/Trustee Three

MICHAEL SMITH
DIRECTOR
140 W RIVER ST STE 5
CADILLAC MI 49601

Officer/Director/Trustee Four

LYNN ROSS
DIRECTOR
407 MAPLEBROOKE LN
CADILLAC MI 49601

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/8/19
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E02 - Management & Technical Assistance
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
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 MICHAEL SMITH
Signature Title DIRECTOR
Signature Date 9/20/19

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