FORM 1023-EZ for GENESIS CENTER OF EXCELLENCE
| Field | Data |
|---|---|
| EIN | 82-2401022 |
| Case Number | EO-2020276-000042 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | GENESIS CENTER OF EXCELLENCE |
| Organization’s Mailing Address | 3189 PRINCETON RD 361 |
| City | FAIRFIELD |
| State | OH |
| ZIP | 45011 |
| Accounting period End | 12 |
| Primary contact name | QUINTON E MOSS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
QUINTON E MOSS
BOARD PRESIDENT
3189 PRINCETON RD 361
FAIRFIELD OH 45011
Officer/Director/Trustee Two
CLYDE GARY
BOARD MEMBER
2636 CINCINNATI DAYTON RD
MIDDLETOWN OH 45044
Officer/Director/Trustee Three
RANDY BALLARD
BOARD MEMBER
8610 DALLASBURG RD
MORROW OH 45152
Officer/Director/Trustee Four
PATRICIA LOZANO
TREASURER
1329 FUDGE DR
BEAVERCREEK OH 45434
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 5/5/2016 |
| Organization Incorporation State | OH |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E32 - Ambulatory Health Center, Community Clinic |
| 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 | Yes |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | QUINTON E MOSS |
| Signature Title | BOARD PRESIDENT |
| Signature Date | 9/30/2020 |
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