FORM 1023-EZ for MELANATED WELLNESS NFP

Field Data
EIN 85-1925941
Case Number EO-2020199-000188
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MELANATED WELLNESS NFP
Organization’s Mailing Address 1370 S WHITEOAK DRIVE 121
City WAUKEGAN
State IL
ZIP 60085
Accounting period End 12
Primary contact name HEATHER PERKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HEATHER PERKINS
CHIEF EXECUTIVE OFFICER /DIRECTOR
1409 DODGE AVE UNIT 2
EVANSTON IL 60201

Officer/Director/Trustee Two

ALEXIS DILLON
CHIEF OPERATING OFFICER/DIRECTOR
1251 LAWRENCE ABT B
CHICAGO IL 60640

Officer/Director/Trustee Three

EUGENE PERKINS
CHIEF FINANCIAL OFFICER /DIRECTOR
1409 DODGE AVE UNIT 2
EVANSTON IL 60201

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/13/2020
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 HEATHER PERKINS
Signature Title CHIEF EXECUTIVE OFFICER /DIRECTOR
Signature Date 7/15/2020

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