FORM 1023-EZ for HEALTH CARE INTEGRATED SCHOOL BASEDHEALTH

Field Data
EIN 47-3399074
Case Number EO-2019122-000105
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTH CARE INTEGRATED SCHOOL BASEDHEALTH
Organization’s Mailing Address PO BOX 213093
City CHULA VISTA
State CA
ZIP 91921
Accounting period End 6
Primary contact name EDNA MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EDNA MILLER
PRESIDENT
PO BOX 213093
CHULA VISTA CA 91921

Officer/Director/Trustee Two

JUSTIN MILLER
TREASURER
PO BOX 213093
CHULA VISTA CA 91921

Officer/Director/Trustee Three

DWAYNE THOMPSON
SECRETARY
PO BOX 213093
CHULA VISTA CA 91921

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/16/14
Organization Incorporation State CA
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 Yes
Correctness Declaration Yes
Signature Name EDNA MILLER
Signature Title PRESIDENT
Signature Date 4/29/19

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