FORM 1023-EZ for THE HEALING WELL

Field Data
EIN 47-5423753
Case Number EO-2016362-000169
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE HEALING WELL
Organization’s Mailing Address 24584 EBELDEN AVENUE
City NEWHALL
State CA
ZIP 91321-3744
Accounting period End 12
Primary contact name CLANDIS PAYNE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT PAYNE
DIRECTOR AND PRESIDENT/CEO
24584 EBELDEN AVENUE
NEWHALL CA 91321-3744

Officer/Director/Trustee Two

ANN THOMAS
DIRECTOR AND SECRETARY
3647 VIRGINIA ROAD
LOS ANGELES CA 90016-5819

Officer/Director/Trustee Three

TAMARA SATTERWHITE
TREASURER/CFO
5314 1/2 PACKARD STREET
LOS ANGELES CA 90019-2650

Officer/Director/Trustee Four

CLANDIS PAYNE
CEO/EXECUTIVE DIRECTOR
24584 EBELDEN AVENUE
NEWHALL CA 91321-3744

Organization’s website NONE
Organization’s email CLANDISP@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/23/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: No
Religious: No
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 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
Signature Title
Signature Date

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