FORM 1023-EZ for NATIONAL RURAL ACCOUNTABLE CARE CONSORTIUM

Field Data
EIN 47-2282858
Case Number EO-2015022-000357
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NATIONAL RURAL ACCOUNTABLE CARE CONSORTIUM
Organization’s Mailing Address PO BOX 1330
City NEVADA CITY
State CA
ZIP 95959
Accounting period End 12
Primary contact name REBECCA EGGEMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TIM PUTNAM
PRESIDENT / DIRECTOR
PO BOX 1330
NEVADA CITY CA 95959

Officer/Director/Trustee Two

MELANIE VAN WINKLE
TREASURER / DIRECTOR
PO BOX 1330
NEVADA CITY CA 95959

Officer/Director/Trustee Three

LYNN BARR
SECRETARY / DIRECTOR
PO BOX 1330
NEVADA CITY CA 95959

Officer/Director/Trustee Four

STEVE BARNETT
DIRECTOR
PO BOX 1330
NEVADA CITY CA 95959

Officer/Director/Trustee Five

CHRISTINE BAUMGARDNER
DIRECTOR
PO BOX 1330
NEVADA CITY CA 95959

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E19 - Nonmonetary Support N.E.C.
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
Signature Title
Signature Date

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