FORM 1023-EZ for GATHERING ROOTS WELLNESS

Field Data
EIN 85-3426377
Case Number EO-2020296-000939
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GATHERING ROOTS WELLNESS
Organization’s Mailing Address 2842 32ND AVE S
City SEATTLE
State WA
ZIP 98144-6112
Accounting period End 12
Primary contact name TRACY L STEWART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

OMITOSIN SHANNON KING
DIRECTOR
1405 24TH AVE UNIT 505
SEATTLE WA 98122

Officer/Director/Trustee Two

NGOC TRAN CHAU
BOARD MEMBER
18235 FREMONT AVE N
SHORELINE WA 98133

Officer/Director/Trustee Three

LISA PRICE
BOARD MEMBER
1129 24TH AVE SOUTH
SEATTLE WA 98145

Officer/Director/Trustee Four

DAMITHIA NIEVES
BOARD MEMBER
11838 42ND AVE S
TUKWILA WA 98168

Officer/Director/Trustee Five

TRACY L STEWART
DIRECTOR
2842 32ND AVE S
SEATTLE WA 98144

Organization’s website GATHERINGROOTS.ORG
Organization’s email GATHERINGROOTSWELLNESS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/16/2020
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A99 - Arts, Culture, and Humanities N.E.C.
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 TRACY L STEWART
Signature Title DIRECTOR
Signature Date 10/19/2020

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