FORM 1023-EZ for COLLABORATIVE WELLNESS INC

Field Data
EIN 85-0621909
Case Number EO-2020129-000154
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COLLABORATIVE WELLNESS INC
Organization’s Mailing Address 797 EAST STREET
City NEW BRITAIN
State CT
ZIP 06051-1701
Accounting period End 12
Primary contact name TAMMY KAY HENDRICKS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TAMMY KAY HENDRICKS
PRESIDENT
797 EAST STREET
NEW BRITAIN CT 06051-1701

Officer/Director/Trustee Two

GENESIS KAGGWA
SECRETARY
30 GRISWOLD STREET
MANCHESTER CT 06040-3991

Officer/Director/Trustee Three

GRACE MILLER
TREASURER
797 EAST STREET
NEW BRITAIN CT 06051-1701

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/6/2020
Organization Incorporation State CT
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: 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TAMMY KAY HENDRICKS
Signature Title PRESIDENT
Signature Date 5/6/2020

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