FORM 1023-EZ for WAYNE COUNTY RURAL HEALTH NETWORK

Field Data
EIN 27-3556809
Case Number EO-2018036-000158
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WAYNE COUNTY RURAL HEALTH NETWORK
Organization’s Mailing Address 6692 MIDDLE ROAD - SUITE 2200
City SODUS
State NY
ZIP 14551-273
Accounting period End 12
Primary contact name EMILIE C SISSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTOPHER RISHEL
PRESIDENT
1204 RIDLEY ROAD
PHELPS NY 14532

Officer/Director/Trustee Two

CALVIN RUTHVEN
VICE PRESIDENT
68 CASTLE STREET
GENEVA NY 14456

Officer/Director/Trustee Three

JACKIE WILLIAMS LPN
SECRETARY
183 NURSERY AVENUE
GENEVA NY 14456

Officer/Director/Trustee Four

NOREEN STRONG
TREASURER
8500 WICKHAM BOULEVARD
SODUS POINT NY 14555

Officer/Director/Trustee Five

EMILIE SISSON
DIRECTOR
3861 STATE ROUTE 414
SENECA FALLS NY 13148

Organization’s website WWW.WAYNECOUNTYRHN.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/2/17
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
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 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 EMILIE SISSON
Signature Title DIRECTOR
Signature Date 2/1/18

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