FORM 1023-EZ for THE COMMUNITY WELL

Field Data
EIN 47-2810974
Case Number EO-2015020-000196
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE COMMUNITY WELL
Organization’s Mailing Address 1 WEST FRONT
City ELPASO
State IL
ZIP 61738
Accounting period End 12
Primary contact name JAIME MOOL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JAIME MOOL
DIRECTOR
463 CR 2570 E
EL PASO IL 61738

Officer/Director/Trustee Two

JENNIFER ROTH
DIRECTOR
450 W THIRD STREET
EL PASO IL 61738

Officer/Director/Trustee Three

COURTNEY REID
DIRECTOR
1 NORTH HOLLOW ROAD
EL PASO IL 61738

Officer/Director/Trustee Four

ALEX BRUCKER
DIRECTOR
298 NORTH CENTRAL
EL PASO IL 61738

Officer/Director/Trustee Five

TIM NEWCOMB
DIRECTOR
1206 CR 2250 E
EL PASO IL 61738

Organization’s website
Organization’s email COMMUNITYWELL55@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/2014
Organization Incorporation State IL
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: Yes
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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
Signature Title
Signature Date

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