FORM 1023-EZ for CONVERGENCE THEATRE

Field Data
EIN 82-1983373
Case Number EO-2018106-000979
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONVERGENCE THEATRE
Organization’s Mailing Address 5727 LARPIN LANE
City ALEXANDRIA
State VA
ZIP 22310
Accounting period End 12
Primary contact name ELENA VELASCO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELENA VELASCO
PRODUCING ARTISTIC DIRECTOR
5727 LARPIN LANE
ALEXANDRIA VA 22310

Officer/Director/Trustee Two

ANNETTE WASNO
MANAGING DIRECTOR
4308 BIRMINGHAM PLA
BELTSVILLE MD 20705

Officer/Director/Trustee Three

SUSAN HALLER
BOARD CHAIRPERSON
711 STRAWFIELD LN
GREAT FALLS VA 22066

Officer/Director/Trustee Four

OLIVIA HALLER
CONNECTIVITY DIRECTOR
2525 10TH ST N APT 520
ARLINGTON VA 22201

Officer/Director/Trustee Five

ALEX MILETICH IV
COMPANY MANAGER
1705 EAST WEST HWY APT 712
SILVER SPRING MD 20910

Organization’s website WWW.CONVERGENCETHEATRE.ORG
Organization’s email INFO@CONVERGENCETHEATRE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/14/17
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A65 - Theater
Organization’s purpose Charitable: No
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 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 ANNETTE WASNO
Signature Title MANAGING DIRECTOR
Signature Date 4/12/18

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