FORM 1023-EZ for CLINICA MEDICA MOSCATI INC

Field Data
EIN 85-2786523
Case Number EO-2021083-000527
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLINICA MEDICA MOSCATI INC
Organization’s Mailing Address 206 MORNINGWALK LANE SW
City HUNTSVILLE
State AL
ZIP 35824
Accounting period End 12
Primary contact name ANGIE HARRIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MAYRA SHORT
PRESIDENT/DIRECTOR/ADMINISTRATIVE D
206 MORNINGWALK LANE SW
HUNTSVILLE AL 35824

Officer/Director/Trustee Two

THOMAS SHORT
TREASURER/DIRECTOR/MEDICAL DIRECTOR
206 MORNINGWALK LANE SW
HUNTSVILLE AL 35824

Officer/Director/Trustee Three

JONATHAN HOWELL
SECRETARY
206 MORNINGWALK LANE SW
HUNTSVILLE AL 35824

Officer/Director/Trustee Four

DOMINIQUE SHORT
DIRECTOR
206 MORNINGWALK LANE SW
HUNTSVILLE AL 35824

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/23/2020
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E32 - Ambulatory Health Center, Community Clinic
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 MAYRA SHORT
Signature Title PRESIDENT/DIRECTOR/ADMINISTRATIVE D
Signature Date 11/16/2020

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