FORM 1023-EZ for HEALTH AND WELLNESS INSTITUTE OF NORTHEASTERN NORTH CAROLINA

Field Data
EIN 47-4729538
Case Number EO-2015306-000420
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALTH AND WELLNESS INSTITUTE OF NORTHEASTERN NORTH CAROLINA
Organization’s Mailing Address 410 EAST MAIN STREET SUITE 202
City ELIZABETH CITY
State NC
ZIP 27909-4466
Accounting period End 12
Primary contact name TIMOTHY A TOLSON MD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TIMOTHY TOLSON
CHAIR OF THE BOARD
410 EAST MAIN STREET SUITE 202
ELIZABETH CITY NC 27909-4466

Officer/Director/Trustee Two

DENAUVO ROBINSON
SECRETARY,TREASURER
410 EAST MAIN STREET SUITE 202
ELIZABETH CITY NC 27909-4466

Officer/Director/Trustee Three

KEITH NORRIS
VOTING MEMBER
410 EAST MAIN STREET SUITE 202
ELIZABETH CITY NC 27909-4466

Organization’s website N/A
Organization’s email HWINENC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2015
Organization Incorporation State NC
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: No
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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