FORM 1023-EZ for PROFESSIONAL HEALTHCARE HOSPICE FOUNDATION INC

Field Data
EIN 26-1094796
Case Number EO-2021027-000302
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PROFESSIONAL HEALTHCARE HOSPICE FOUNDATION INC
Organization’s Mailing Address 7619 LITTLE RIVER TURNPIKE STE 600
City ANNANDALE
State VA
ZIP 22003
Accounting period End 12
Primary contact name BENJAMIN KINDER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EILEEN DECESARE
PRESIDENT
10300 HUNT COUNTRY LANE
VIENNA VA 22182

Officer/Director/Trustee Two

PILAR GODOY
DIRECTOR
1641 W BALMORAL AVE
CHICAGO IL 60640

Officer/Director/Trustee Three

NELLIE ROBINSON
DIRECTOR
16617 ALEXANDER MANOR DR
SILVER SPRING MD 20905

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/13/2007
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P74 - Hospice
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 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 No
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 EILEEN DECESARE
Signature Title PRESIDENT
Signature Date 12/4/2020

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