FORM 1023-EZ for THE INTERNATIONAL INSTITUTE OF SELF-EMPOWERMENT

Field Data
EIN 85-2854487
Case Number EO-2020258-000697
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE INTERNATIONAL INSTITUTE OF SELF-EMPOWERMENT
Organization’s Mailing Address 1209 CENTRAL AVENUE S SUITE 138
City KENT
State WA
ZIP 98032
Accounting period End 12
Primary contact name MICHAEL GROSS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL GROSS
PRESIDENT/DIRECTOR
1209 CENTRAL AVE S STE 138
KENT WA 98032-7439

Officer/Director/Trustee Two

PATRICK SNOW
CHIEF FINANCIAL OFFICER
59 KALKENA LOOP
WAILUKU HI 96793

Officer/Director/Trustee Three

KIMBER BENNETT
CHAIR PERSON OF THE GOVERNING BODY
1714 CANNAS COURT
CARSLBAD CA 92011-5103

Officer/Director/Trustee Four

RENEE GORDON
SECRETARY
19325 LONDELIUS ST RM 313
NORTHRIDGE CA 91324-3510

Officer/Director/Trustee Five

JIM CONNOLLY
VICE PRESIDENT
19325 LONDELIUS ST RM 313
NORTHRIDGE CA 91324-3510

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/2020
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
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 Yes
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 MICHAEL GROSS
Signature Title PRESIDENT/DIRECTOR
Signature Date 9/12/2020

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