FORM 1023-EZ for COMMUNITY AND FAMILY HEALTH INC

Field Data
EIN 84-2476148
Case Number EO-2019210-000430
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY AND FAMILY HEALTH INC
Organization’s Mailing Address 5165 E 74TH PLACE
City INDIANAPOLIS
State IN
ZIP 46250
Accounting period End 12
Primary contact name DAVETTA A HENDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVETTA A HENDERSON
PRESIDENT / CEO
5165 E 74TH PLACE
INDIANAPOLIS IN 46250

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/20/19
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DAVETTA A HENDERSON
Signature Title PRESIDENT / CEO
Signature Date 7/26/19

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