FORM 1023-EZ for CHAI LIFE NEBRASKA INC

Field Data
EIN 47-3472334
Case Number EO-2016132-000188
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHAI LIFE NEBRASKA INC
Organization’s Mailing Address 2104 SOUTH 110 STREET
City OMAHA
State NE
ZIP 68144
Accounting period End 12
Primary contact name DOUG WOLFSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DOUG WOLFSON
PRESIDENT
2104 SOUTH 110 STREET
OMAHA NE 68144

Officer/Director/Trustee Two

DEBORAH SALOMON
VICE PRESIDENT
9930 BURT STREET APT 214
OMAHA NE 68114

Officer/Director/Trustee Three

CLAUDIA SHERMAN
SECRETARY
12756 NICHOLAS CIRCLE
OMAHA NE 68154

Officer/Director/Trustee Four

BETH DWORKIN
TREASURER
3139 NORTH 151 STREET
OMAHA NE 68116

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/12/2015
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W01 - 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 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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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