FORM 1023-EZ for COUNT MY HEALTH EQUITY FOUNDATION

Field Data
EIN 86-3729562
Case Number EO-2021132-000227
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COUNT MY HEALTH EQUITY FOUNDATION
Organization’s Mailing Address 207 YOUNG STREET
City TALLAHASSEE
State FL
ZIP 32301
Accounting period End 12
Primary contact name CHENELLE HARRIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHENELLE HARRIS
EXECUTIVE DIRECTOR
11802 FOREST KNOLL COURT
BOWIE MD 20720

Officer/Director/Trustee Two

THOMAS HAYNES
BOARD MEMBER
207 YOUNG STREET
TALLAHASSEE FL 32301

Officer/Director/Trustee Three

CHERYL HAYNES
BOARD MEMBER
207 YOUNG STREET
TALLAHASSEE FL 32301

Organization’s website WWW.COUNTMYHEALTH.COM
Organization’s email CHARRIS@COUNTMYHEALTH.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/7/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E11 - Single Organization Support
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name CHENELLE HARRIS
Signature Title EXECUTIVE DIRECTOR
Signature Date 5/10/2021

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