FORM 1023-EZ for CHRYSALIS COMMUNITY WELLNESS NFP
| Field | Data |
|---|---|
| EIN | 83-0803621 |
| Case Number | EO-2018172-000170 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | CHRYSALIS COMMUNITY WELLNESS NFP |
| Organization’s Mailing Address | PO BOX 63 |
| City | CARNATION |
| State | WA |
| ZIP | 98014 |
| Accounting period End | 12 |
| Primary contact name | ELISA BERGQUIST |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
ELISA BERGQUIST
DIRECTOR/PRESIDENT/TREASURER
3990 333RD AVE NE
CARNATION WA 98014
Officer/Director/Trustee Two
KATIE HANLEY
DIRECTOR AND SECRETARY
33730 NE 138TH PL
DUVALL WA 98019
Officer/Director/Trustee Three
TASSIN SMITH
DIRECTOR AND VICE PRESIDENT
32251 EAST MORRISON ST
CARNATION WA 98014
| Organization’s website | WWW.CHRYSALISCOMMUNITYWELLNESS.ORG |
|---|---|
| Organization’s email | ELISA@CHRYSALISCOMMUNITYWELLNESS.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 5/24/18 |
| Organization Incorporation State | WA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E50 - Rehabilitative Medical 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 | 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 | ELISA BERGQUIST |
| Signature Title | DIRECTOR/PRESIDENT/TREASURER |
| Signature Date | 6/19/18 |
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