FORM 1023-EZ for COMMUNITY HEALTH ACCESS INC

Field Data
EIN 82-4193612
Case Number EO-2018106-000309
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY HEALTH ACCESS INC
Organization’s Mailing Address 1007 E VINE STREET
City KISSIMMEE
State FL
ZIP 34744
Accounting period End 6
Primary contact name SHANNON D HOAGLAND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN FISCHER
PRESIDENT
1007 E VINE STREET
KISSIMMEE FL 34744

Officer/Director/Trustee Two

CASSANDRA FISCHER
TREASURER
1007 E VINE STREET
KISSIMMEE FL 34744

Officer/Director/Trustee Three

DEBRA PERLEBERG
SECRETARY
1007 E VINE STREET
KISSIMMEE FL 34744

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/25/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
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 No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 DEBRA PERLEBERG
Signature Title SECRETARY
Signature Date 4/10/18

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