FORM 1023-EZ for CREATING CHANGE COUNSELING CENTER

Field Data
EIN 83-0581337
Case Number EO-2018282-000459
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CREATING CHANGE COUNSELING CENTER
Organization’s Mailing Address 181 J HOWARD BLVD
City MOUNT ARLINGTON
State NJ
ZIP 7856
Accounting period End 12
Primary contact name GLORIA CORREA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GLORIA CORREA
CEO
24 MAPLE LANE
MOUNT ARLINGTON NJ 7856

Officer/Director/Trustee Two

CHARLENE ALLEN
VICE PRESIDENT
131 BIRCH LEAF DRIVE
MILFORD PA 18337

Officer/Director/Trustee Three

RUBENICE LATORRE
TREASURER
24 MAPLE LANE
MOUNT ARLINGTON NJ 7856

Officer/Director/Trustee Four

VALENTIN VASQUEZ
CFO
382 NORTH 7TH STREET
PROSPECT PARK NJ 7405

Officer/Director/Trustee Five

JOHN VILLADA
CLINICAL DIRECTOR
10 COOPER DRIVE
BOONTON NJ 7005

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/30/18
Organization Incorporation State NJ
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: No
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 GLORIA CORREA
Signature Title CEO
Signature Date 10/7/18

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