FORM 1023-EZ for QUEST NURSING HEALTH CLINIC

Field Data
EIN 83-1467390
Case Number EO-2020147-000633
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name QUEST NURSING HEALTH CLINIC
Organization’s Mailing Address 917 HARRISON ST
City OAKLAND
State CA
ZIP 94607
Accounting period End 12
Primary contact name STACEY ELETU
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACEY ELETU
CHIEF EXECUTIVE OFFICER
917 HARRISON ST
OAKLAND CA 94607

Officer/Director/Trustee Two

LILY SALAZAR
SECRETARY
917 HARRISON ST
OAKLAND CA 94607

Officer/Director/Trustee Three

NICOLE JOHNSON
CHIEF FINANCIAL OFFICER
917 HARRISON ST
OAKLAND CA 94607

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/26/2018
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E32 - Ambulatory Health Center, Community Clinic
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 Yes
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name STACEY ELETU
Signature Title CHIEF EXECUTIVE OFFICER
Signature Date 5/23/2020

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