FORM 1023-EZ for NORTHERN VALLEY MEDICAL CENTER INC

Field Data
EIN 23-2387167
Case Number EO-2015259-000213
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTHERN VALLEY MEDICAL CENTER INC
Organization’s Mailing Address 411 SHENANDOAH ROAD
City RINGTOWN
State PA
ZIP 17967
Accounting period End 12
Primary contact name LOUISE HETHERINGTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRIAN IRSLINGER
PRESIDENT
411 SHENANDOAH ROAD
RINGTOWN PA 17967

Officer/Director/Trustee Two

THOMAS MURRAY
V-P
411 SHENANDOAH ROAD
RINGTOWN PA 17967

Officer/Director/Trustee Three

LOUISE HETHERINGTON
SECRETARY
411 SHENANDOAH ROAD
RINGTOWN PA 17967

Officer/Director/Trustee Four

MCHELE FOLK
TREASURER
411 SHENANDOAH ROAD
RINGTOWN PA 17976

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/1972
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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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