FORM 1023-EZ for ALAMEDA COUNTY CARE ALLIANCE COLLABORATIVE

Field Data
EIN 81-5021531
Case Number EO-2018247-000717
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ALAMEDA COUNTY CARE ALLIANCE COLLABORATIVE
Organization’s Mailing Address 8501 INTERNATIONAL BLVD
City OAKLAND
State CA
ZIP 94621
Accounting period End 12
Primary contact name CYNTHIA CARTER PERRILLIAT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DR ALVIN MCLEAN PHD
TREASURER
8501 INTERNATIONAL BLVD
OKAKLAND CA 94621

Officer/Director/Trustee Two

REV DR J ALFRED SMITH JR
SECRETARY
8501 INTERNATIONAL BLVD
OAKLAND CA 94621

Officer/Director/Trustee Three

CYNTHIA CARTER PERRILLIAT MPA
EXECUTIVE DIRECTOR/CHAIRMAN
8501 INTERNATIONAL BLVD
OAKLAND CA 94621

Organization’s website HTTP://ACCAREALLIANCE.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/28/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P01 - 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 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 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 CYNTHIA CARTER PERRILLIAT MPA
Signature Title EXECUTIVE DIRECTOR/CHAIRMAN
Signature Date 8/31/18

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