FORM 1023-EZ for CLINICAL NURSE SPECIALIST INSTITUTE

Field Data
EIN 81-4345954
Case Number EO-2019322-000198
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLINICAL NURSE SPECIALIST INSTITUTE
Organization’s Mailing Address 401 EDGEWATER PLACE SUITE 600
City WAKEFIELD
State MA
ZIP 1880
Accounting period End 12
Primary contact name THOMAS PAPPAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN FOWLER
TREASURER
401 EDGEWATER PLACE SUITE 600
WAKEFIELD MA 1880

Officer/Director/Trustee Two

MELISSA CRAFT
CHAIRPERSON
401 EDGEWATER PLACE SUITE 600
WAKEFIELD MA 1880

Officer/Director/Trustee Three

SHARON HORNER
VICE CHAIR
401 EDGEWATER PLACE SUITE 600
WAKEFIELD MA 1880

Officer/Director/Trustee Four

GAYLE TIMMERMAN
TRUSTEE
401 EDGEWATER PLACE SUITE 600
WAKEFIELD MA 1880

Officer/Director/Trustee Five

KATHLEEN ZAVOTSKY
TRUSTEE
401 EDGEWATER PLACE SUITE 600
WAKEFIELD MA 1880

Organization’s website HTTPS://NACNS.ORG/CNS-INSTITUTE/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/14/16
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E90 - Nursing Services (General)
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MELISSA CRAFT
Signature Title CHAIRPERSON
Signature Date 11/14/19
EIN 81-4345954
Case Number EO-2016322-000191
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLININCAL NURSE SPECIALIST INSTITUTE
Organization’s Mailing Address C/O J HARTON-100 N 20 ST-STE 400
City PHILADELPHIA
State PA
ZIP 19103
Accounting period End 12
Primary contact name JULIA BAYLOR HARTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELISSA CRAFT
CHAIR
1100 N STONEWALL AVENUE
OKLAHOMA CITY OK 73117

Officer/Director/Trustee Two

SUSAN FOWLER
CHAIR
165 ESSEX AVE- APT 106
METUCHEN NJ 08840

Officer/Director/Trustee Three

ANNE HYSONE
SECTY
2469 MEDFORD CT
DACULA GA 30019

Officer/Director/Trustee Four

NANCY ALBERT
TREASURER
11305 PINE ACRES LANE
CHESTERLAND OH 44026

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/2016
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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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