FORM 1023-EZ for RIVER VALLEY SENIORS AT HOME

Field Data
EIN 83-3127487
Case Number EO-2019035-000894
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RIVER VALLEY SENIORS AT HOME
Organization’s Mailing Address 82 NORTH RD
City WALPOLE
State NH
ZIP 3608
Accounting period End 12
Primary contact name TARA A SAD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TARA SAD
MANAGING DIRECTOR
82 NORTH ROAD
WALPOLE NH 3608

Officer/Director/Trustee Two

THOMAS CROUSE
OFFICER
192 MARCH HILL ROAD
WALPOLE NH 3608

Officer/Director/Trustee Three

ADRIAN BASORA
OFFICER
67 OLD NORTH MAIN STREET
WALPOLE NH 3608

Officer/Director/Trustee Four

SUSAN DALESSIO
OFFICER
57 ALSTEAD CENTER ROAD
WALPOLE NH 3608

Officer/Director/Trustee Five

PEGGY PSCHIRRER
OFFICER
11 OLD NORTH MAIN STREET
WALPOLE NH 3608

Organization’s website WWW.RIVERVALLEYSENIORSATHOME.ORG
Organization’s email RIVERVALLEYSENIORSATHOME@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/13/18
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y99 - Mutual/Membership Benefit Organizations, Other N.E.C.
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 Yes
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 TARA SAD
Signature Title MANAGING DIRECTOR
Signature Date 1/14/19

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