FORM 1023-EZ for ENVISIONING YOUTH EMPOWERMENT RETREAT INC

Field Data
EIN 47-3694095
Case Number EO-2015113-000083
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ENVISIONING YOUTH EMPOWERMENT RETREAT INC
Organization’s Mailing Address 1217 MANASSAS COURT UNIT C
City RALEIGH
State NC
ZIP 27609
Accounting period End 12
Primary contact name ALAN A CHASE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ALAN CHASE
PRESIDENT DIRECTOR
1217 MANASSAS COURT UNIT C
RALEIGH NC 27609

Officer/Director/Trustee Two

ERIC GALINDO
VP DIRECTOR
1540 SPRING GARDEN STREET
GREENSBORO NC 27412

Officer/Director/Trustee Three

MICHAEL COX
TREASURER DIRECTOR
3931 MARCOM STREET APT A
RALEIGH NC 27606

Officer/Director/Trustee Four

PRESTON JOHNSON
SECRETARY DIRECTOR
4700 WESTGROVE ST APT 318
RALEIGH NC 27606

Officer/Director/Trustee Five

JEWEL SHUPING
DIRECTOR
3931 MARCOM STREET APT A
RALEIGH NC 27606

Organization’s website WWW.EYERETREAT.ORG
Organization’s email EYERETREAT@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/30/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P86 - Blind/Visually Impaired Centers, 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 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
Signature Title
Signature Date

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