FORM 1023-EZ for COMMUNITY HEALTH AND WELLNESS OUTREACH INCORPORATED

Field Data
EIN 82-3852267
Case Number EO-2018234-000099
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY HEALTH AND WELLNESS OUTREACH INCORPORATED
Organization’s Mailing Address 1275 WOODCREST TERRACE
City WOODLYN
State PA
ZIP 19094
Accounting period End 6
Primary contact name ELAINE M BRYANT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELAINE M BRYANT
EXECUTIVE DIRECTOR
1275 WOODCREST TERRACE
WOODLYN PA 19094

Officer/Director/Trustee Two

ELLEN M JAMES
DIRECTOR OF NURSING
1275 WOODCREST TERRACE
WOODLYN PA 19094

Officer/Director/Trustee Three

JOSEPH A VERDIER
MEDICAL DIRECTOR
8491 REYNOLDSWOOD DRIVE
REYNOLDSBURG OH 43068

Officer/Director/Trustee Four

LUCRETIA J VERDIER
SECRETARY
8491 REYNOLDSWOOD DRIVE
REYNOLDSBURG OH 43068

Officer/Director/Trustee Five

JACQUELINE GREENFIELD COLLINS
LOGISTICS COORDINATOR
16305 KOLLIN AVENUE
CLEVELAND OH 44128

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/3/18
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
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 ELAINE M BRYANT
Signature Title EXECUTIVE DIRECTOR
Signature Date 8/20/18

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