FORM 1023-EZ for HERB FOLK COMMUNITY MEDICINE

Field Data
EIN 82-1501414
Case Number EO-2017195-000324
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HERB FOLK COMMUNITY MEDICINE
Organization’s Mailing Address 121 WASHINGTON STREET
City PETALUMA
State CA
ZIP 94952-2952
Accounting period End 12
Primary contact name ERIN WILKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERIN WILKINS
CEO
121 WASHINGTON STREET
PETALUMA CA 94952-2952

Officer/Director/Trustee Two

DEREK WILKINS
SECRETARY/CFO
524 BRYCE CANYON CT
PETALUMA CA 94954-1577

Officer/Director/Trustee Three

ALYSSA MELODY
DIRECTOR
1528 M STREET APT 3
ARCATA CA 95521-5767

Officer/Director/Trustee Four

ABBY RAPPOPORT
DIRECTOR
2108 MOUNTAIN AVE
SANTA BARBARA CA 93101-4616

Organization’s website HERBFOLK.ORG
Organization’s email HELLO@HERBFOLK.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/9/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion 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 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
Signature Title
Signature Date

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