FORM 1023-EZ for CLARKSTON COMMUNITY HEALTH CENTER INC

Field Data
EIN 46-1402143
Case Number EO-2015331-000262
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLARKSTON COMMUNITY HEALTH CENTER INC
Organization’s Mailing Address 3700 MARKET STREET SUITE E1
City CLARKSTON
State GA
ZIP 30021
Accounting period End 12
Primary contact name SAEED RAEES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SAEED RAEES
PRESIDENT
3700 MARKET STREET SUITE E1
CLARKSTON GA 30021

Officer/Director/Trustee Two

GULSHAN HARJEE
CHIEF MEDICAL OFFICER
3700 MARKET STREET SUITE E1
CLARKSTON GA 30021

Officer/Director/Trustee Three

YASEEN ABUBAKER
DIRECTRO
3700 MARKET STREET SUITE E1
CLARKSTON GA 30021

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/2012
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E21 - Community Health Systems
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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