FORM 1023-EZ for CAMELLIA SUPPORT FOR WOMEN

Field Data
EIN 86-3550620
Case Number EO-2021148-000658
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAMELLIA SUPPORT FOR WOMEN
Organization’s Mailing Address 10712 HINTON WAY
City MANASSAS
State VA
ZIP 20112-5899
Accounting period End 12
Primary contact name MIKA MATTINGLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MIKA MATTINGLY
PRESIDENT
10712 HINTON WAY
MANASSAS VA 20112-5899

Officer/Director/Trustee Two

IZUMI SHIINA
SECRETARY
6811 BREEZEWOOD TERRACE
ROCKVILLE MD 20852-4321

Officer/Director/Trustee Three

SABELLA LIM
TREASURER
3908 FISH POND LN
GLEN ALEN VA 23060-5945

Organization’s website
Organization’s email CAMELLIA.NPO@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/13/2021
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other 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 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 MIKA MATTINGLY
Signature Title PRESIDENT
Signature Date 5/27/2021

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