FORM 1023-EZ for SELF-INJURY SUPPORT GROUPS OF NORTHWEST INDIANA
| Field | Data |
|---|---|
| EIN | 82-4552165 |
| Case Number | EO-2018128-000393 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | SELF-INJURY SUPPORT GROUPS OF NORTHWEST INDIANA |
| Organization’s Mailing Address | 416 E 86TH AVENUE |
| City | MERRILLVILLE |
| State | IN |
| ZIP | 46410 |
| Accounting period End | 3 |
| Primary contact name | LYNDA SMITH OR RUTH HALSTEAD |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
CASSANDRA KORMENDY
MSW, LSW (ADVISORY MEMBER)
104 S 16TH STREET
CHESTERTON IN 46304
Officer/Director/Trustee Two
CHRISTOPHER DRAPEAU
PH.D., NCSP, ADVISORY MEMBER
1800 CHAPEL DR MEIER HALL 122
VALPARAISO IN 46383
Officer/Director/Trustee Three
RUTH HALSTEAD
LMFT, EXECUTIVE DIRECTOR, TREASURER
416 E 86TH AVENUE
MERRILLVILLE IN 46410
Officer/Director/Trustee Four
HERIBERTO ARREGUIN
ADVISORY MEMBER
3234 GLENWOOD ST
HIGHLAND IN 46322
Officer/Director/Trustee Five
LYNDA SMITH
RN, CHIEF EXECUTIVE, CHAIRPERSON
416 E 86TH AVENUE
MERRILLVILLE IN 46410
| Organization’s website | SELFINJURYNWI.ORG |
|---|---|
| Organization’s email | SELFINJURYNWI@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 3/16/18 |
| Organization Incorporation State | IN |
| 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 | 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 | LYNDA SMITH |
| Signature Title | RN, CHIEF EXECUTIVE, CHAIRPERSON |
| Signature Date | 5/1/18 |
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