FORM 1023-EZ for CREATIVE HEALING SPACE INC
| Field | Data |
|---|---|
| EIN | 84-4123924 |
| Case Number | EO-2020013-000206 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | CREATIVE HEALING SPACE INC |
| Organization’s Mailing Address | 709 10TH STREET |
| City | WORTHINGTON |
| State | MN |
| ZIP | 56187 |
| Accounting period End | 12 |
| Primary contact name | SUREEPORN SOMPAMITWONG |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
SUREEPORN SOMPAMITWONG
CHIEF EXECUTIVE OFFICER
323 WEST DOVER STREET
WORTHINGTON MN 56187
Officer/Director/Trustee Two
GILLIAN SINGLER
CHIEF FINANCIAL OFFICER/ CHAIRPERSO
620 CHICAGO STREET
LAKEFIELD MN 56150
Officer/Director/Trustee Three
LEAH GOSSUM
VICE PRESENT
529 LAKE AVE
WORTHINGTON MN 56187
Officer/Director/Trustee Four
MICHELLE RAMIREZ
DIRECTOR
32765 840TH ST
BREWSTER MN 56131
Officer/Director/Trustee Five
SAMANTHA BRINK
SECRETARY
301 11TH AVE
WORTHINGTON MN 56187
| Organization’s website | |
|---|---|
| Organization’s email | SUREE.84@OUTLOOK.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/29/2019 |
| Organization Incorporation State | MS |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E60 - Health Support Services |
| 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 | SUREEPORN SOMPAMITWONG |
| Signature Title | CHIEF EXECUTIVE OFFICER |
| Signature Date | 1/9/2020 |
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