FORM 1023-EZ for COLLABORATIVE HEALTH SOLUTIONS INC
| Field | Data |
|---|---|
| EIN | 81-1702834 |
| Case Number | EO-2016071-000079 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | COLLABORATIVE HEALTH SOLUTIONS INC |
| Organization’s Mailing Address | 1396 SW 180TH AVENUE |
| City | PEMBROKE PINES |
| State | FL |
| ZIP | 33029 |
| Accounting period End | 12 |
| Primary contact name | MICHAEL VIERA ESQ |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $400.00 |
Officer/Director/Trustee One
DAMION JACKSON
CHAIRPERSON
1396 SW 180TH AVENUE
PEMBROKE PINES FL 33029
Officer/Director/Trustee Two
DEAN GREEN
VP
3822 SW 167TH TERRACE
MIRARMAR FL 33027
Officer/Director/Trustee Three
ANDRE YOUNG
SECRETARY
3208 EAST COLONIAL DRIVE 209
ORLANDO FL 32803
Officer/Director/Trustee Four
MONIQUE HAYES
TREASURER
1396 SW 180TH AVENUE
PEMBROKE PINES FL 33029
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 2/29/2016 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | G12 - Fund Raising and/or Fund Distribution |
| 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 | 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 | |
| Signature Title | |
| Signature Date |
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