FORM 1023-EZ for SOUTHERN CALIFORNIA PUBLIC HEALTH ASSOCIATION

Field Data
EIN 80-0395459
Case Number EO-2017296-000361
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHERN CALIFORNIA PUBLIC HEALTH ASSOCIATION
Organization’s Mailing Address PO BOX 92453
City LONG BEACH
State CA
ZIP 90809
Accounting period End 12
Primary contact name DALE WORSHAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARINA GETTAS
PRESIDENT
PO BOX 92453
LONG BEACH CA 90809

Officer/Director/Trustee Two

CHERISE CHARLESWELL
IMMEDIATE PAST PRESIDENT
PO BOX 92453
LONG BEACH CA 90809

Officer/Director/Trustee Three

AMY HONG
SECRETARY
PO BOX 92453
LONG BEACH CA 90809

Officer/Director/Trustee Four

MARIA CALDERON
TREASURER
PO BOX 92453
LONG BEACH CA 90809

Officer/Director/Trustee Five

DALE WORSHAM
FISCAL MANAGER
PO BOX 92453
LONG BEACH CA 90809

Organization’s website SCPHA.ORG
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2009
Organization Incorporation State CA
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: No
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 Yes
Donation of funds Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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