FORM 1023-EZ for EMPOWER WELLNESS INC

Field Data
EIN 81-2771269
Case Number EO-2018254-000124
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EMPOWER WELLNESS INC
Organization’s Mailing Address 1937 MASSACHUSSETTS ST
City FORT COLLINS
State CO
ZIP 80525
Accounting period End 12
Primary contact name SUSAN ACKERMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALISSA ACKERMAN
EXECUTIVE DIRECTOR
1937 MASSACHUSETTS ST
FORT COLLINS CO 80525

Officer/Director/Trustee Two

SUSAN ACKERMAN
CHAIRPERSON
3408 GREEN SPRING DR
FORT COLLINS CO 80528

Officer/Director/Trustee Three

RYAN MAYEDA
VICE-CHAIRPERSON
4963 C STREET
GREELEY CO 80634

Officer/Director/Trustee Four

JULIE ACKERMAN
TREASURER
3617 PRECISION DR APT H161
FORT COLLINS CO 80528

Officer/Director/Trustee Five

JESSICA LEER
SECRETARY
7901 E BELLEVIEW AVE APT 459
ENGLEWOOD CO 80111

Organization’s website WWW.EMPOWERWELLNESSINC.COM
Organization’s email EMPOWERWELLNESSINC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/27/16
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 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 SUSAN ACKERMAN
Signature Title CHAIRPERSON
Signature Date 9/9/18

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