FORM 1023-EZ for WORTHY WELLNESS

Field Data
EIN 87-1887455
Case Number EO-2021267-000192
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WORTHY WELLNESS
Organization’s Mailing Address 2811 PENNSYLVANIA AVE SE
City WASHINGTON
State DC
ZIP 20020
Accounting period End 12
Primary contact name HABIB SHAMTE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AGNES MASSAWE
CFO & DIR & TREASURER
2811 PENNSYLVANIA AVE SE
WASHINGTON DC 20020

Officer/Director/Trustee Two

HABIB SHAMTE
PRES & CEO & DIRECTOR
2811 PENNSYLVANIA AVE SE
WASHINGTON DC 20020

Officer/Director/Trustee Three

ARNETTA LEGREE
DIRECTOR
2811 PENNSYLVANIA AVE SE
WASHINGTON DC 20020

Officer/Director/Trustee Four

BRUCE TISDALE
SECRETARY
2811 PENNSYLVANIA AVE SE
WASHINGTON DC 20020

Officer/Director/Trustee Five

ONYEAGHALA NWAEHINE
DIRECTOR
2811 PENNSYLVANIA AVE SE
WASHINGTON DC 20020

Organization’s website
Organization’s email ALEGREE@DISTRICTHEALTHCARESERVICES.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents No
Organization Incorporation Date 5/19/2021
Organization Incorporation State DC
Contains Limitation No
Does not expressly empower No
Contains dissolution No
National Taxonomy of Exempt Entities (NTEE) code F30 - Mental Health Treatment - Multipurpose and 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 Yes
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 No
Signature Name HABIB SHAMTE
Signature Title PRES & CEO & DIRECTOR
Signature Date 9/22/2021

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