FORM 1023-EZ for WELLSPRING19 INC

Field Data
EIN 84-2289484
Case Number EO-2019284-000037
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WELLSPRING19 INC
Organization’s Mailing Address PO BOX 8611
City PELHAM
State NY
ZIP 10803
Accounting period End 5
Primary contact name VIRGINIA CONNELLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VIRGINIA CONNELLY
DIRECTOR
960 GRANT AVENUE
PELHAM NY 10803

Officer/Director/Trustee Two

WILLIAM ROLON
DIRECTOR
29 CREAMERY DRIVE
NEW WINDSOR NY 12553

Officer/Director/Trustee Three

SUSAN CARAS
DIRECTOR
2455 HUNETERBROOK ROAD
YORKTOWN HEIGHTS NY 10598

Officer/Director/Trustee Four

MARTIN ROGERS
DIRECTOR
292 EAST 150 STREET
BRONX NY 10451

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/19
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X90 - Interfaith Issues
Organization’s purpose Charitable: Yes
Religious: Yes
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 VIRGINIA CONNELLY
Signature Title DIRECTOR
Signature Date 10/7/19

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