FORM 1023-EZ for UTAH SOCIETY OF ADDICTION MEDICINE

Field Data
EIN 46-4588718
Case Number EO-2019050-000449
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name UTAH SOCIETY OF ADDICTION MEDICINE
Organization’s Mailing Address 195 N 1950 W
City SALT LAKE CITY
State UT
ZIP 84116
Accounting period End 12
Primary contact name MEGAN WEST
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATHERINE CARLSON
PRESIDENT
PO BOX 526381
SALT LAKE CITY UT 84152

Officer/Director/Trustee Two

PAULA COOK
PRESIDENT-ELECT
PO BOX 526381
SALT LAKE CITY UT 84152

Officer/Director/Trustee Three

CHRISTINA GALLOP
TREASURER
PO BOX 526381
SALT LAKE CITY UT 84152

Officer/Director/Trustee Four

JAVIER BALLESTER
SECRETARY
PO BOX 526381
SALT LAKE CITY UT 84152

Officer/Director/Trustee Five

MEGAN WEST
CHAPTER ADMINISTRATOR
PO BOX 526381
SALT LAKE CITY UT 84152

Organization’s website HTTPS://WWW.ASAM.ORG/MEMBERSHIP/STATE-CHAPTERS/LIST/UTAH
Organization’s email UTAHASAM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/31/90
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G03 - Professional Societies, Associations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name MEGAN WEST
Signature Title CHAPTER ADMINISTRATOR
Signature Date 2/15/19

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