FORM 1023-EZ for THE COLLABORATIVE COMMUNITY MISSIONINC

Field Data
EIN 84-2836579
Case Number EO-2019263-000242
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE COLLABORATIVE COMMUNITY MISSIONINC
Organization’s Mailing Address 6501 HILLCREST AVE
City ORCHARD PARK
State NY
ZIP 14127
Accounting period End 12
Primary contact name JESSICA M SILLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSICA M SILLS
PRESIDENT
6501 HILLCREST AVE
ORCHARD PARK NY 14127

Officer/Director/Trustee Two

AMY MUMBACH
VICE PRESIDENT
6501 HILLCREST AVE
ORCHARD PARK NY 14127

Officer/Director/Trustee Three

SUZANNE KRUEGER
SECRETARY
6501 HILLCREST AVE
ORCHARD PARK NY 14127

Officer/Director/Trustee Four

KATY SHAUL
TREASURER
6501 HILLCREST AVE
ORCHARD PARK NY 14127

Officer/Director/Trustee Five

JAHANNA KURTZ
BOARD MEMBER
6501 HILLCREST AVE
ORCHARD PARK NY 14127

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/19
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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 JESSICA M SILLS
Signature Title PRESIDENT
Signature Date 9/18/19

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