FORM 1023-EZ for EMPOWERMENT SERVICES

Field Data
EIN 45-2913941
Case Number EO-2014251-000506
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMPOWERMENT SERVICES
Organization’s Mailing Address 352 SOUTH DENVER STREET SUITE 202
City SALT LAKE CITY
State UT
ZIP 84111-3063
Accounting period End 12
Primary contact name JAN HENDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JAN HENDERSON
BOARD PRESIDENT
1790 SOUTH 800 EAST
SALT LAKE CITY UT 84105-3142

Officer/Director/Trustee Two

JEAN CANESTRINI
TREASURER
499 ASPEN DRIVE
PARK CITY UT 84098

Officer/Director/Trustee Three

JACQUELINE GOMEZ ARIAS
BOARD MEMBER
1152 SOUTH 800 WEST
SALT LAKE CITY UT 84104

Organization’s website HTTP://WWW.EMPOWERMENTSERVICES.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/15/2011
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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