FORM 1023-EZ for THE URBAN HEALTH COLLABORATIVE

Field Data
EIN 85-2883865
Case Number EO-2021028-000052
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE URBAN HEALTH COLLABORATIVE
Organization’s Mailing Address 220 DAVIDSON AVE
City SOMERSET
State NJ
ZIP 08873
Accounting period End 12
Primary contact name ZAIRE ALI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ZAIRE ALI
OFFICER
76 CEDAR LANE APT A
HIGHLAND PARK NJ 08904

Officer/Director/Trustee Two

KHIZRA SAJJAD
DIRECTOR
76 CEDAR LANE APT A
HIGHLAND PARK NJ 08904

Officer/Director/Trustee Three

OMAR CLARK
DIRECTOR
76 CEDAR LANE APT A
HIGHLAND PARK NJ 08904

Organization’s website THEURBANHEALTHCOLLABORATIVE.COM
Organization’s email THEURBANHEALTHCOLLABORATIVE@GMAI.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/6/2020
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States Yes
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ZAIRE ALI
Signature Title OFFICER
Signature Date 12/12/2020

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