FORM 1023-EZ for DIVINITY HEALTH INC

Field Data
EIN 81-0892685
Case Number EO-2018171-000524
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DIVINITY HEALTH INC
Organization’s Mailing Address 6901 SAND PEBBLE AVE
City TEMPLE TERRACE
State FL
ZIP 33637
Accounting period End 12
Primary contact name LILLIAN OKPALEKEE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LILLIAN OKPALEKE
DIRECTOR
6901 SAND PEBBLE AVE
TEMPLE TERRACE FL 33637

Officer/Director/Trustee Two

KETO NORD
OFFICER
6901 SAND PEBBLE AVE
TEMPLE TERRACE FL 33637

Officer/Director/Trustee Three

ROD WAY
OFFICER
6901 SAND PEBBLE AVE
TEMPLE TERRACE FL 33637

Organization’s website
Organization’s email DIVINITYHEALTHINC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/23/15
Organization Incorporation State FL
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 Yes
Donation of funds Yes
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 LILLIAN OKPALEKE
Signature Title DIRECTOR
Signature Date 6/6/18

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