FORM 1023-EZ for SELECT CHOICE HOME CARE INC

Field Data
EIN 81-0807721
Case Number EO-2015355-000284
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SELECT CHOICE HOME CARE INC
Organization’s Mailing Address 547 ROUTE 67
City MECHANICVILLE
State NY
ZIP 12118
Accounting period End 12
Primary contact name TOM RICHARDSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TOM RICHARDSON
CEO/SECRETARY
547 ROUTE 67
MECHANICVILLE NY 12118

Officer/Director/Trustee Two

ROBERT VANNATTEN
CFO/TREASURER
225 SOUTH SWAN STREET
ALBANY NY 12202

Officer/Director/Trustee Three

JOESPH MAZURYK
DIR. OF BUSINESS DEV.
155 GORDINIER ROAD
DELANSON NY 12053

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L81 - Home Improvement and Repairs
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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