FORM 1023-EZ for COMMUNITY HEALTH ASSISTANCE PROGRAM

Field Data
EIN 82-2394087
Case Number EO-2018117-000227
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY HEALTH ASSISTANCE PROGRAM
Organization’s Mailing Address PO BOX 415
City CLIFTON
State AZ
ZIP 85533-415
Accounting period End 12
Primary contact name LAURA DORRELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAURA DORRELL
TREASURER
112 COMB STREET
CLIFTON AZ 85533

Officer/Director/Trustee Two

VERONICA BABB
SECRETARY
98 AGAVE
MORENCI AZ 85540

Officer/Director/Trustee Three

TERESA ANDAZOLA
CHAIR
105 TAMARISK
MORENCI AZ 85540

Organization’s website
Organization’s email GREENLEECHAP@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/15/17
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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 LAURA DORRELL
Signature Title TREASURER
Signature Date 4/25/18

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