FORM 1023-EZ for NOTHERN COCHISE NURSING HOME ASSOCIATION INC

Field Data
EIN 81-4764402
Case Number EO-2017044-000323
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NOTHERN COCHISE NURSING HOME ASSOCIATION INC
Organization’s Mailing Address PO BOX 285
City WILCOX
State AZ
ZIP 85644
Accounting period End 12
Primary contact name TIMOTHY BOWLBY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TIMOTHY BOWLBY
PRESIDENT
806 W SOTO ST
WILLCOX AZ 85643

Officer/Director/Trustee Two

LADONNA BURGESS
VICE PRESIDENT
1675 W PACKING PLANT RD
WILLCOX AZ 85643

Officer/Director/Trustee Three

CLAUDIA MINK
SECRETARY-TREASURER
2045 N DAVIS RANCH RD
WILLCOX AZ 85643

Officer/Director/Trustee Four

CAROL DUNAGAN
BOARD OF DIRECTOR
701 N ARIZONA AVE
WILLCOX AZ 85643

Officer/Director/Trustee Five

JOHN CROPPER
BOARD OF DIRECTOR
1300 W AIRPORT RD
WILLCOX AZ 85643

Organization’s website NCNHA.WEEBLY.COM
Organization’s email NCNHA.IN.WILLCOX@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/14/2016
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E91 - Nursing, Convalescent Facilities
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 No
One Third Support Gifts Yes
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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