FORM 1023-EZ for NATIVE AMERICAN SPIRITUAL WELLNESS CENTER

Field Data
EIN 82-1586911
Case Number EO-2017237-000121
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NATIVE AMERICAN SPIRITUAL WELLNESS CENTER
Organization’s Mailing Address 2955 SAN BRUNO AVE
City SAN FRANCISCO
State CA
ZIP 94134
Accounting period End 12
Primary contact name SHARYN GRAYSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REX AQUINO
PRESIDENT
520 PENINSULA AVE APT 5
BURLINGAME CA 94134

Officer/Director/Trustee Two

ANNA BELDA
SECRETARY
1265 WALLER ST
SAN FRANCSCO CA 94117

Officer/Director/Trustee Three

ANTON AYSON
TREASURER/CFO
44 FAIRMONT DRIVE
DALY CITY CA 94015

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/24/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
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 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
Signature Title
Signature Date

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