FORM 1023-EZ for EXCELLENT HOME HEALTH

Field Data
EIN 84-4672410
Case Number EO-2020192-000311
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EXCELLENT HOME HEALTH
Organization’s Mailing Address 2950 E OLD SETTLERS BLVD UNIT 44
City ROUND ROCK
State TX
ZIP 78665
Accounting period End 1
Primary contact name BRISLY NTOH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRISLY NTOH
CEO
2950 E OLD SETTELERS
ROUND ROCK TX 78665

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/13/2020
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E92 - Home Health Care
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BRISLY NTOH
Signature Title CEO
Signature Date 7/8/2020

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