FORM 1023-EZ for CALIFORNIA COMMUNITY HEALTH AND EDUCATION INITIATIVE

Field Data
EIN 30-0944417
Case Number EO-2016218-000192
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CALIFORNIA COMMUNITY HEALTH AND EDUCATION INITIATIVE
Organization’s Mailing Address PO BOX 943
City GEORGETOWN
State CA
ZIP 95634-9567
Accounting period End 12
Primary contact name CHYNELL CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHYNELL CLARK
DIRECTOR
3146 BRAUER RD
GEORGETOWN CA 95634-9567

Officer/Director/Trustee Two

JEFF ROTH
SECRETARY
1990 SOUTHWEST EXPY APT2
SAN JOSE CA 95126-3425

Officer/Director/Trustee Three

EULA JEAN BENDELE
TREASURER
793 COAKLEY DR
SAN JOSE CA 95117-1706

Organization’s website
Organization’s email CCHEINITIATIVE@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/9/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 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
Signature Title
Signature Date

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