FORM 1023-EZ for CAROLINAS CROSS CULTURAL HEALTH SERVICES

Field Data
EIN 46-2170493
Case Number EO-2014230-000330
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAROLINAS CROSS CULTURAL HEALTH SERVICES
Organization’s Mailing Address 502 EAST GODBOLT STREET
City MARION
State SC
ZIP 29505-9374
Accounting period End 12
Primary contact name JIM ALLEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JIM ALLEN
CHAIRMAN
905 BEVERLY DRIVE
FLORENCE SC 29501-9374

Officer/Director/Trustee Two

EDNA RODRIGUEZ
VICE CHAIRMAN
215 MILLSTONE ROAD APT O
FLORENCE SC 29505-9374

Officer/Director/Trustee Three

JAY LINGLE
TREASURER
446 SECOND LOOP ROAD
FLORENCE SC 29205-9374

Officer/Director/Trustee Four

ANNETTE DIAZ
SECRETARY
504 YMCA LANE
FLORENCE SC 29205-9374

Officer/Director/Trustee Five

MAURO DIAZ
TRUSTEE
504 YMCA LANE
FLORENCE SC 29505-9374

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/2013
Organization Incorporation State SC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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
Signature Title
Signature Date

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