FORM 1023-EZ for NOURISH CLT

Field Data
EIN 47-4319374
Case Number EO-2016077-000025
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NOURISH CLT
Organization’s Mailing Address 4225 KINGSWOOD ROAD
City CHARLOTTE
State NC
ZIP 28226
Accounting period End 12
Primary contact name MIRANDA DAUPHINEE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MIRANDA DAUPHINEE
PRESIDENT
1170 MORGANTON RD
PINEHURST NC 28374

Officer/Director/Trustee Two

SHAUNNA RUSHING
VICE PRESIDENT
4225 KINGSWOOD ROAD
CHARLOTTE NC 28266

Officer/Director/Trustee Three

PAM MICOSKY
SECRETARY
8219 GOLF RIDGE DRIVE
CHARLOTTE NC 28277

Organization’s website WWW.NOURISHCLT.COM
Organization’s email MIRANDA@NOURISHCLT.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S81 - Women's Service 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 Yes
Donation of funds Yes
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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