FORM 1023-EZ for REVIVE COMMUNITY HEALTH CENTER
| Field | Data |
|---|---|
| EIN | 81-1816896 |
| Case Number | EO-2020265-000510 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | REVIVE COMMUNITY HEALTH CENTER |
| Organization’s Mailing Address | 1226 BEACH ST |
| City | FLINT |
| State | MI |
| ZIP | 48502 |
| Accounting period End | 9 |
| Primary contact name | BRANDON WALLACE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
TERRI COLBERT
CHAIRPERSON
38573 GLASTONBERRY
FARMINGTON HILLS MI 48331
Officer/Director/Trustee Two
SHARAE ROSBOROUGH
1ST VICE CHAIR
6265 GARNET LN
GRAND BLANC MI 48439
Officer/Director/Trustee Three
EZRA TILLMAN
FOUNDER
1226 BEACH ST
FLINT MI 48502
Officer/Director/Trustee Four
MICHAEL PETTIGREW
TREASURER
1414 HICKORY HOLLOW DRIVE
FLINT MI 48532
Officer/Director/Trustee Five
JULIE WINKFIELD
SECRETARY
3401 CHAMBERS ST
FLINT MI 48507
| Organization’s website | REVIVECHC.ORG |
|---|---|
| Organization’s email | REVIVECHC@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/3/2016 |
| Organization Incorporation State | MI |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | W99 - Public, Society Benefit - Multipurpose and Other 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 | No |
| Legislation influence | No |
| Compensation of Officer director trustee | Yes |
| 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 | Yes |
| Signature Name | EZRA TILLMAN |
| Signature Title | FOUNDER |
| Signature Date | 9/18/2020 |
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