FORM 1023-EZ for EMPOWER HEALTH CHANGE
| Field | Data |
|---|---|
| EIN | 83-4632145 |
| Case Number | EO-2019144-000192 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | EMPOWER HEALTH CHANGE |
| Organization’s Mailing Address | 1084 W WALDEN WOOD DRIVE |
| City | MURRAY |
| State | UT |
| ZIP | 84123 |
| Accounting period End | 12 |
| Primary contact name | NICHOLAS A TRUJILLO |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
NICHOLAS TRUJILLO
DIRECTOR/PRESIDENT/SECRETARY
2152 W TAYLOR VIEW DR
SOUTH JORDAN UT 84095
Officer/Director/Trustee Two
RUSS SHERMAN
DIRECTOR
13319 S MOSELEY WAY
HERRIMAN UT 84096
Officer/Director/Trustee Three
MICHAEL GJENVICK
DIRECTOR
90 E 600 S APT 513
SALT LAKE CITY UT 84111
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/15/19 |
| Organization Incorporation State | UT |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E99 - Health - General and Rehabilitative N.E.C. |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes Scientific: Yes 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 | NICHOLAS TRUJILLO |
| Signature Title | DIRECTOR/PRESIDENT/SECRETARY |
| Signature Date | 5/22/19 |
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