FORM 1023-EZ for CINCINNATUS HEALTH CARE INC

Field Data
EIN 82-0719069
Case Number EO-2018039-000087
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CINCINNATUS HEALTH CARE INC
Organization’s Mailing Address 574 WOODLAND RD 44
City MANSFIELD
State OH
ZIP 44906
Accounting period End 12
Primary contact name ALYSON STEELE BERIDON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PETER SANDWALL
DIRECTOR
574 WOODLAND RD 44
MANSFIELD OH 44906

Officer/Director/Trustee Two

SUSAN SANDWALL
DIRECTOR
574 WOODLAND RD 44
MANSFIELD OH 44906

Officer/Director/Trustee Three

ERNESTO GUTIERREZ
DIRECRTOR
3212 MCEVER WOODS TR
ATLANTA GA 30101

Officer/Director/Trustee Four

BRADFORD JARRETT
DIRECTOR
28126 LAUREL GARDEN LANE
FULSHEAR TX 77441

Officer/Director/Trustee Five

SARAH MCKEE
DIRECTOR
5340 TIMBERHOLLOW LANE
CINCINNATI OH 45247

Organization’s website N/A
Organization’s email PASANDWALL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/7/16
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: Yes
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 Yes
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name PETER SANDWALL
Signature Title DIRECTOR
Signature Date 2/6/18

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