FORM 1023-EZ for HISTORIC COMMUNITY REHABILITATION INC

Field Data
EIN 82-2512420
Case Number EO-2017233-000114
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HISTORIC COMMUNITY REHABILITATION INC
Organization’s Mailing Address 99 S WALNUT ST UNIT 646
City YOUNGSTOWN
State OH
ZIP 44501
Accounting period End 12
Primary contact name MICHAEL BOBIC
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL BOBIC
CHAIRMAN
113 JOAN CIRCLE
CAMPBELL OH 44405

Officer/Director/Trustee Two

ANDREW RAUZEN
SECRETARY
640 MATAWAN DR
CAMPBELL OH 44405

Officer/Director/Trustee Three

MEGAN TOMES
TREASURER
47 RUSSELL ST
MANCHESTER NH 03104

Officer/Director/Trustee Four

JEREMY MORALES
VICE TREASURER
76 MEMORIAL CIRCLE
CAMPBELL OH 44405

Officer/Director/Trustee Five

VASILIOS PATRIS
VICE SECRETARY
637 HYATT AVE
CAMPBELL OH 44405

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/4/2017
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S31 - Urban, Community Economic Development
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
Signature Title
Signature Date

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