FORM 1023-EZ for ALLIANCE FOR HEALTH AND REHABILITATION

Field Data
EIN 83-2124424
Case Number EO-2018282-000472
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ALLIANCE FOR HEALTH AND REHABILITATION
Organization’s Mailing Address 122 BUTTLES AVE
City COLUMBUS
State OH
ZIP 43215
Accounting period End 12
Primary contact name DALE C DEUBLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DALE DEUBLER
PRESIDENT
122 BUTTLES AVE
COLUMBUS OH 43215-1401

Officer/Director/Trustee Two

ALLISON RISH
VICE PRESIDENT
8328 KIRKALDY DR
DUBLIN OH 43017-9730

Officer/Director/Trustee Three

JESSICA LEWIS
TREASURER
6022 INISHMORE LANE
DUBLIN OH 43017-3472

Officer/Director/Trustee Four

WENDY KING
SECRETARY
281 E CLEARVIEW ST
WORTHINGTON OH 43085-4085

Officer/Director/Trustee Five

JULIE CONRY
AT-LARGE
6857 PERRY ST
WORTHINGTON OH 43085-2814

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/6/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E53 -
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 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 DALE DEUBLER
Signature Title PRESIDENT
Signature Date 10/6/18

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