FORM 1023-EZ for HEALTHY DETROIT

Field Data
EIN 45-4522667
Case Number EO-2016253-000455
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALTHY DETROIT
Organization’s Mailing Address 298 E PALMER ST
City DETROIT
State MI
ZIP 48202
Accounting period End 12
Primary contact name NICHOLAS MUKHTAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ASHA SHAJAHAN
BOARD CHAIR
468 CADIEUX RD
GROSSE POINTE MI 48230

Officer/Director/Trustee Two

TERRENCE REEVES
BOARD VICE CHAIR
1442 BRUSH ST
DETROIT MI 48226

Officer/Director/Trustee Three

RICHARD BAKKEN
BOARD TREASURER
288 E PALMER ST
DETROIT MI 48202

Officer/Director/Trustee Four

CHERYL JOHNSON
BOARD SECRETARY
26 PETERBORO ST
DETROIT MI 48201

Officer/Director/Trustee Five

NICHOLAS MUKHTAR
FOUNDER
298 E PALMER ST
DETROIT MI 48202

Organization’s website WWW.HEALTHYDETROIT.ORG
Organization’s email INFO@HEALTHYDETROIT.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/16/2012
Organization Incorporation State MI
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
Signature Title
Signature Date

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