FORM 1023-EZ for VIBRANT COMMUNITY WELLNESS

Field Data
EIN 84-4593132
Case Number EO-2020080-000187
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name VIBRANT COMMUNITY WELLNESS
Organization’s Mailing Address 2104 PACIFIC AVE
City BLOOMINGTON
State IL
ZIP 61701
Accounting period End 12
Primary contact name TAYLOR LICCAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TAYLOR LICCAR
PRESIDENT / DIRECTOR
2104 PACIFIC AVE
BLOOMINGTON IL 61701

Officer/Director/Trustee Two

KEVIN LICCAR
SECRETARY / TREASURER
2104 PACIFIC AVE
BLOOMINGTON IL 61701

Officer/Director/Trustee Three

GRETA JANIS
DIRECTOR
2104 PACIFIC AVE
BLOOMINGTON IL 61701

Officer/Director/Trustee Four

GINA JOHNSON
DIRECTOR
2104 PACIFIC AVE
BLOOMINGTON IL 61701

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/2/2020
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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 TAYLOR LICCAR
Signature Title PRESIDENT / DIRECTOR
Signature Date 3/18/2020

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