FORM 1023-EZ for BEYOND ADDICTION MOSAIC
| Field | Data |
|---|---|
| EIN | 84-4240443 |
| Case Number | EO-2020072-000135 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | BEYOND ADDICTION MOSAIC |
| Organization’s Mailing Address | 2133 BIRCH HOLLOW COVE |
| City | DRAPER |
| State | UT |
| ZIP | 84020 |
| Accounting period End | 12 |
| Primary contact name | RACHAEL PIOLTINI |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
RACHAEL PIOLTINI
DIRECTOR/ TRUSTEE
2133
DRAPER UT 84020
Officer/Director/Trustee Two
JAMILYN YAZZIE
DIRECTOR
189W AMERICAN AVE
MURRAY UT 84107
Officer/Director/Trustee Three
RICHARD YOUNG
DIRECTOR/TRUSTEE
341 EAST LAMBORNE
SLC UT 84115
Officer/Director/Trustee Four
BLAS GARCIA
DIRECTOR
137E 4800 S
MURRAY UT 84107
| Organization’s website | |
|---|---|
| Organization’s email | BEYONDADDICTIONMOSAIC@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/9/2020 |
| Organization Incorporation State | UT |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P20 - Human Service Organizations - Multipurpose |
| 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 | Yes |
| 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 | RACHAEL PIOLTINI |
| Signature Title | DIRECTOR/ TRUSTEE |
| Signature Date | 3/10/2020 |
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