FORM 1023-EZ for BIFROST HEALTH ADVOCATE SERVICES

Field Data
EIN 83-0652466
Case Number EO-2018158-000277
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BIFROST HEALTH ADVOCATE SERVICES
Organization’s Mailing Address 108 DILL DRIVE
City PIEDMONT
State SC
ZIP 29673-8974
Accounting period End 12
Primary contact name ANDREA SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA SMITH
PRESIDENT/TREASURER
108 DILL DRIVE
PIEDMONT SC 29673-8974

Officer/Director/Trustee Two

JULIE KELLY
VICE PRESIDENT/SECRETARY
20 HAYNES STREET
PIEDMONT SC 29673-8974

Officer/Director/Trustee Three

JAMES CHAPIN
DIRECTOR AT LARGE
35-46 79TH STREET
JACKSON HEIGHTS NY 11372

Organization’s website N/A
Organization’s email ANDREA.B.SMITH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/24/18
Organization Incorporation State SC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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 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 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 ANDREA SMITH
Signature Title PRESIDENT/TREASURER
Signature Date 6/5/18

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