FORM 1023-EZ for MY VILLAGE HEALTH

Field Data
EIN 83-3415744
Case Number EO-2019042-000480
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MY VILLAGE HEALTH
Organization’s Mailing Address 9971 CYRANDALL DR
City OAKTON
State VA
ZIP 22124
Accounting period End 12
Primary contact name JACQUELINE KINYAMU-AKUNDA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JACQUELINE KINYAMU-AKUNDA
DIRECTOR
9971 CYRANDALL DR
OAKTON VA 22124

Officer/Director/Trustee Two

CHIDOZIE AMUZIE
DIRECTOR
5TH BETH DR
AMBLER PA 19002

Officer/Director/Trustee Three

FRANCIS FONYUY TUKOV
DIRECTOR
699 SKYLINE DR
LAKE HOPATCONG NJ 7849

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/28/18
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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 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 JACQUELINE KINYAMU-AKUNDA
Signature Title DIRECTOR
Signature Date 2/9/19

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