FORM 1023-EZ for BETHLEHEM HAITI MISSION

Field Data
EIN 83-3719787
Case Number EO-2019058-000442
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BETHLEHEM HAITI MISSION
Organization’s Mailing Address 11910 HOLLY TREE COURT
City BELTSVILLE
State MD
ZIP 20705
Accounting period End 6
Primary contact name FADINEL TREMONT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FADINEL TREMONT
PRESIDENT
11910 HOLLY TREE COURT
BELTSVILLE MD 20705

Officer/Director/Trustee Two

OSPER JEAN-SIMON
COUNSELOR
9319 AVENEL RD
SILVER SPRING MD 20903

Officer/Director/Trustee Three

MARK HEAZLIT
COUNSELOR
7809 EARNSHAW DRIVE
BRANDYWINE MD 20613

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/2/18
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q34 -
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 Yes
Donation of funds Yes
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 Yes
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name FADINEL TREMONT
Signature Title PRESIDENT
Signature Date 2/25/19

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