FORM 1023-EZ for CONNECTIVE HEALING INC

Field Data
EIN 83-2516019
Case Number EO-2018320-000151
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONNECTIVE HEALING INC
Organization’s Mailing Address 658 COUNTY ROUTE 6
City HIGH FALLS
State NY
ZIP 12440-5803
Accounting period End 12
Primary contact name LEONARD EASTER ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN ELLSWORTH
PRESIDENT DIRECTOR
658 COUNTY ROUTE 6
HIGH FALLS NY 12440-5803

Officer/Director/Trustee Two

KRISTA KAUFMAN
DIRECTOR
658 COUNTY ROUTE 6
HIGH FALLS NY 12440-5803

Officer/Director/Trustee Three

ELIZABETH RANDALL
DIRECTOR
10421 SW BANK ROAD
VASHON WA 98070-4666

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/13/18
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development 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 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 JOHN ELLSWORTH
Signature Title PRESIDENT DIRECTOR
Signature Date 11/14/18

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