FORM 1023-EZ for ASOCIACION LATINO AMERICANA PARA LASALUD INC

Field Data
EIN 84-3695152
Case Number EO-2019343-000446
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ASOCIACION LATINO AMERICANA PARA LASALUD INC
Organization’s Mailing Address 8321 OFFICE PARK DR
City DOUGLASVILLE
State GA
ZIP 30134-6936
Accounting period End 12
Primary contact name PAUL KENNEDY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANGELICA RIVAS-KENNEDY
EXECUTIVE DIRECTOR
4132 HIGH COUNTRY DR
DOUGLASVILLE GA 30135

Officer/Director/Trustee Two

PAUL KENNEDY
CHIEF OPERATING OFFICER
4132 HIGH COUNTRY DR
DOUGLASVILLE GA 30135

Officer/Director/Trustee Three

SHAWN HORAN
BOARD MEMBER
5246 STERLING COVE CT
MABLETON GA 30126

Officer/Director/Trustee Four

SHAUNA HORAN
BOARD MEMBER
5246 STERLING COVE CT
MABLETON GA 30126

Officer/Director/Trustee Five

TATIANA VILLAREAL-OTALORA
BOARD MEMBER
314 GRANVILLE CT
ATLANTA GA 30328

Organization’s website WWW.ALASHEALTH.ORG
Organization’s email INFO@ALASHEALTH.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/8/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F32 - Community Mental Health Center
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 Yes
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 PAUL KENNEDY
Signature Title CHIEF OPERATING OFFICER
Signature Date 12/6/2019

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