FORM 1023-EZ for GIRLS EMPOWERED MOTIVATED STRENGTHENED

Field Data
EIN 81-1602749
Case Number EO-2016246-000146
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GIRLS EMPOWERED MOTIVATED STRENGTHENED
Organization’s Mailing Address 40 EAST ST
City BROOKFIELD
State VT
ZIP 05036
Accounting period End 12
Primary contact name KATIE JICKLING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATIE JICKLING
DIRECTOR
40 EAST ST
BROOKFIELD VT 05036

Officer/Director/Trustee Two

MARYA MERRIAM
ASSOCIATE DIRECTOR
4917 VT RT 14
E. RANDOLPH VT 05041

Officer/Director/Trustee Three

EMILY LEVAN
BOARD CHAIR
2435 RIDGE ROAD
RANDOLPH CENTER VT 05060

Officer/Director/Trustee Four

REBECCA HAUSER
BOARD SECRETARY
1386 RISH HILL RD
RANDOLPH VT 05060

Officer/Director/Trustee Five

KRISTIN CHANDLER
BOARD TREASURER
2 FAIRVIEW ST
RANDOLPH VT 05060

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/15/2015
Organization Incorporation State VT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O22 - Girls Clubs
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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