FORM 1023-EZ for COMMUNITY COUNSELING AND INTERVENTION SERVICES

Field Data
EIN 82-5041968
Case Number EO-2018101-000340
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY COUNSELING AND INTERVENTION SERVICES
Organization’s Mailing Address 3426 BAHIA BLANCA WEST UNIT N
City LAGUNA WOODS
State CA
ZIP 92637
Accounting period End 12
Primary contact name VICTORIA HERBERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VICTORIA HERBERT
PRESIDENT
3426 BAHIA BLANCA WEST UNIT N
LAGUNA WOODS CA 92637

Officer/Director/Trustee Two

KAROLYN HERBERT
SECRETARY
3426 BAHIA BLANCA WEST UNIT N
LAGUNA WOOD CA 92637

Organization’s website
Organization’s email VICTORIA.HERBERT@VANGUARD.EDU
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/15/18
Organization Incorporation State CA
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: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name VICTORIA HERBERT
Signature Title PRESIDENT
Signature Date 4/9/18

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