FORM 1023-EZ for SOCIAL IMPACT WINES

Field Data
EIN 82-0849776
Case Number EO-2017172-000261
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOCIAL IMPACT WINES
Organization’s Mailing Address 27 EAST VINE STREET
City LODI
State CA
ZIP 95240
Accounting period End 6
Primary contact name STACEY HORSLEY HANSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACEY HORSLEY HANSEN
PRESIDENT
27 E VINE STREET
LODI CA 95240

Officer/Director/Trustee Two

JEFF HANSEN
DIRECTOR
27 E VINE STREET
LODI CA 95240

Officer/Director/Trustee Three

SUSIE GARCIA
DIRECTOR
27 E VINE STREET
LODI CA 95240

Officer/Director/Trustee Four

MARY HANSEN
TREASURER
27 E VINE STREET
LODI CA 95240

Organization’s website WWW.SOCIALIMPACTWINES.ORG
Organization’s email STACEY@SOCIALIMPACTWINES.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 Yes
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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