FORM 1023-EZ for CAPABLE PEDIATRIC HEALTHCARE

Field Data
EIN 83-4413844
Case Number EO-2019129-000177
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAPABLE PEDIATRIC HEALTHCARE
Organization’s Mailing Address 13113 HAMPTON FARM LANE
City BRANDYWINE
State MD
ZIP 20613
Accounting period End 12
Primary contact name DANIELLE MARIE MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIELLE MARIE MARTIN
PRESIDENT
13113 HAMPTON FARM LANE
BRANDYWINE MD 20613

Officer/Director/Trustee Two

DENISE MARTIN
BOARD MEMBER
13113 HAMPTON FARM LANE
BRANDYWINE MD 20613

Officer/Director/Trustee Three

SOPHIA EBINUM
BOARD MEMBER
13502 GREENCASTLE RIDGE TERR
BURTONSVILLE MD 20866

Officer/Director/Trustee Four

LUWAM SEHAYE
BOARD MEMBER
2948 M STREET SE
WASHINGTON DC 20019

Officer/Director/Trustee Five

BRITTANY SEWELL
BOARD MEMBER
3153 SEDGEWICK DRIVE
WALDORF MD 20603

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/15/19
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
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 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 DANIELLE MARIE MARTIN
Signature Title PRESIDENT
Signature Date 5/7/19

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