FORM 1023-EZ for QUALIA RESEARCH INSTITUTE

Field Data
EIN 82-5457325
Case Number EO-2018325-000032
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name QUALIA RESEARCH INSTITUTE
Organization’s Mailing Address 293 ARROWHEAD WAY
City SCOTTS VALLEY
State CA
ZIP 95066
Accounting period End 12
Primary contact name Romeo Stevens
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROMEO STEVENS
DEVELOPMENT DIRECTOR
293 ARROWHEAD WAY
SCOTTS VALLEY CA 95066

Officer/Director/Trustee Two

MIKE JOHNSON
PROJECT MANAGER
293 ARROWHEAD WAY
SCOTTS VALLEY CA 95066

Officer/Director/Trustee Three

SCOTT JACKISCH
PROJECT MANAGER
293 ARROWHEAD WAY
SCOTTS VALLEY CA 95066

Organization’s website QUALIARESEARCHINSTITUTE.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code U50 - Biological, Life Science Research
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: Yes
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 ROMEO STEVENS
Signature Title DEVELOPMENT DIRECTOR
Signature Date 11/19/18

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