FORM 1023-EZ for CONNECT RESTORE THRIVE COUNSELING GROUP

Field Data
EIN 85-2379583
Case Number EO-2020224-000316
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONNECT RESTORE THRIVE COUNSELING GROUP
Organization’s Mailing Address 3845 SCOTTS VALLEY DR
City KLAMATH FALLS
State OR
ZIP 97601
Accounting period End 12
Primary contact name TESSA TURNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TESSA TURNER
DIRECTOR
751
ANCHORAGE AK 99504

Officer/Director/Trustee Two

CLAYTON AUGUSTINE
DIRECTOR
3845 SCOTT VALLEY DR
KLAMATH FALLS OR 97601

Officer/Director/Trustee Three

WILLIAM WINGARD
DIRECTOR
3845 SCOTT VALLEY DR
KLAMATH FALLS OR 97601

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/6/2020
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F32 - Community Mental Health Center
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 TESSA TURNER
Signature Title DIRECTOR
Signature Date 8/6/2020

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