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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