FORM 1023-EZ for NANOSHELL RESEARCH INSTITUTE

Field Data
EIN 81-5141897
Case Number EO-2017054-000434
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NANOSHELL RESEARCH INSTITUTE
Organization’s Mailing Address 840 WEST 1700 S
City SALT LAKE CITY
State UT
ZIP 84115
Accounting period End 12
Primary contact name JEFFREY L SQUIRES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AGNES OSTAFIN
CHAIRPERSON
259 SPRINGRIDGE DR
NORTH SALT LAKE UT 84054

Officer/Director/Trustee Two

HIROSHI MIZUKAMI
DIRECTOR
1502 N OXFORD AVE
PASADENA CA 91104-2734

Officer/Director/Trustee Three

BLAKE JOHNSON
DIRECTOR
1060 EAST 100 SOUTH SUITE 110
SALT LAKE CITY UT 84102

Officer/Director/Trustee Four

STEPHANIE SCHMIDT
DIRECTOR
42405 NW LOOKOVER DR
BANKS OR 97106

Officer/Director/Trustee Five

BO HEDLUND
DIRECTOR
2049 16TH STREET NW
NEW BRIGHTON MN 55112

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/18/2017
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H05 - Research Institutes and/or Public Policy Analysis
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 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
Signature Title
Signature Date

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