FORM 1023-EZ for LIFEPATH COMMUNITY HOSPICE INCORPORATED

Field Data
EIN 82-0612169
Case Number EO-2018190-000460
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIFEPATH COMMUNITY HOSPICE INCORPORATED
Organization’s Mailing Address 18 SOUTH MAIN STREET
City JOHNSTOWN
State OH
ZIP 43031
Accounting period End 12
Primary contact name WILLIAM WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM WILLIAMS
PRESIDENT
9521 BENNINGTON CHAPEL ROAD
CENTERBURG OH 43011

Officer/Director/Trustee Two

MICHELLE MORRISON
TREASURER
5046 ROLLING ROCK COURT
COLUMBUS OH 43229

Officer/Director/Trustee Three

SUSAN BLUM
VICE-PRESIDENT
500 WEST HIGHLAND
ZANESVILLE OH 43701

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/3/17
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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 WILLIAM WILLIAMS
Signature Title PRESIDENT
Signature Date 7/5/18

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