FORM 1023-EZ for CHAPLAINCY CARE INC

Field Data
EIN 46-4417294
Case Number EO-2017275-000707
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHAPLAINCY CARE INC
Organization’s Mailing Address 404 JOHNSON ROAD
City PLANT CITY
State FL
ZIP 33566
Accounting period End 12
Primary contact name DR DANIEL R MIDDLEBROOKS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIEL MIDDLEBROOKS
PRESIDENT
404 JOHNSON ROAD
PLANT CITY FL 33566

Officer/Director/Trustee Two

ARIENNE MIDDLEBROOKS
CEO
404 JOHNSON ROAD
PLANT CITY FL 33566

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2013
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
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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