FORM 1023-EZ for KHADIJAH MEDICAL CLINIC INC

Field Data
EIN 47-2412263
Case Number EO-2018078-000329
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KHADIJAH MEDICAL CLINIC INC
Organization’s Mailing Address 4922 NORTH 56TH STREET
City MILWAUKEE
State WI
ZIP 53218
Accounting period End 12
Primary contact name MORRIS M KROMAH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MORRIS KROMAH
PRESIDENT/EXECUTIVE DIRECTOR
4922 NORTH 56TH ST
MILWAUKEE WI 53218

Officer/Director/Trustee Two

MAMADEE KONNEH
VICE PRESIDENT
3730 SOUTH MASSACHUSETTS AVE
MILWAUKEE WI 53220

Officer/Director/Trustee Three

LOSENE SANOE
TREASURER CFO
7321 ZANE AVE NORTH
BROOKLYN PARK MN 55443

Officer/Director/Trustee Four

SEKOU KAMARA
SECRETARY
7005 ONYX CT
CAPITAL HEIGHTS MD 20743

Organization’s website WWW.KHADIJAHMEDICALCLINIC.ORG
Organization’s email MORRISKROMAH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/27/15
Organization Incorporation State WI
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: 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 No
Donation of funds No
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MORRIS KROMAH
Signature Title PRESIDENT/EXECUTIVE DIRECTOR
Signature Date 3/15/18

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