FORM 1023-EZ for COLLABORATIVE MEDICINE AND HEALINGCIRCLE

Field Data
EIN 47-3099531
Case Number EO-2015253-000369
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COLLABORATIVE MEDICINE AND HEALINGCIRCLE
Organization’s Mailing Address 340 C STREET
City WEST SACRAMENTO
State CA
ZIP 95605
Accounting period End 12
Primary contact name TAMMY WALLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JEFF GOTA
PRESIDENT
623 20TH STREET
SACRAMENTO CA 95811

Officer/Director/Trustee Two

TAMMY WALLS
SECRETARY/TREASURER
340 C STREET
WEST SACRAMENTO CA 95605

Officer/Director/Trustee Three

PAULA DENHAM
BOARD MEMBER
4408 LA MIRADA CIRCLE
FAIR OAKS CA 95628

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/14/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
Organization’s purpose Charitable: Yes
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 Yes
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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