FORM 1023-EZ for SOUTHWEST MICHIGAN HEALTH INFORMATION MANAGEMENT ASSOCIATION

Field Data
EIN 38-3636814
Case Number EO-2016267-000156
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHWEST MICHIGAN HEALTH INFORMATION MANAGEMENT ASSOCIATION
Organization’s Mailing Address 6268 109TH AVE
City PULLMAN
State MI
ZIP 49450
Accounting period End 12
Primary contact name SHELLY HUSTAFA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELLE HUSTAFA
TREASURER
300 68TH ST SE
GRAND RAPIDS MI 49548

Officer/Director/Trustee Two

AMANDA METZLER
PRESIDENT
800 COOPER
SAGINAW MI 49602

Officer/Director/Trustee Three

ERICA BAILEY
PRESIDENT ELECT
515 MICHIGAN ST NE
GRAND RAPIDS MI 49503

Organization’s website SWMHIMA.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G03 - Professional Societies, Associations
Organization’s purpose Charitable: No
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 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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