FORM 1023-EZ for SERENITY CENTER AZ INC

Field Data
EIN 83-2569067
Case Number EO-2019044-000435
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SERENITY CENTER AZ INC
Organization’s Mailing Address 1075 S STATE RT 260
City COTTONWOOD
State AZ
ZIP 85326
Accounting period End 12
Primary contact name THOMAS J GADD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANNETTA ZILLER
DIRECTOR/PRESIDENT
1075 S STATE RT 260
COTTONWOOD AZ 86326

Officer/Director/Trustee Two

DIANE JOENS
VICE-PRESIDENT
1075 S STATE RT 260
COTTONWOOD AZ 86326

Officer/Director/Trustee Three

CAROL MENDENHALL
TREASURER
1075 S STATE RT 260
COTTONWOOD AZ 86326

Officer/Director/Trustee Four

ELISSA JEWELL
SECRETARY
1075 S STATE RT 260
COTTONWOOD AZ 86326

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/19/18
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F42 - Rape Victim Services
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ANNETTA ZILLER
Signature Title DIRECTOR/PRESIDENT
Signature Date 2/11/19

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