FORM 1023-EZ for CHOSEN BREAKTHROUGH COLLABORATIVE

Field Data
EIN 84-4255927
Case Number EO-2020097-000045
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CHOSEN BREAKTHROUGH COLLABORATIVE
Organization’s Mailing Address 340 N SAM HOUSTON PKWY E SUITE A258
City HOUSTON
State TX
ZIP 77060
Accounting period End 12
Primary contact name DARRYL KELLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHARLES LADAY
DIRECTOR
340 N SAM HOUSTON PKWY E SUITE A258
HOUSTON TX 77479

Officer/Director/Trustee Two

CATINA ERWIN
DIRECTOR
340 N SAM HOUSTON PKWY E SUITE A258
HOUSTON TX 77040

Officer/Director/Trustee Three

SHOSHANNN MC GAUGH
DIRECTOR
340 N SAM HOUSTON PKWY E SUITE A258
HOUSTON TX 77040

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/3/2020
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 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 CHARLES LADAY
Signature Title DIRECTOR
Signature Date 4/2/2020

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