FORM 1023-EZ for SOUTHLAND MINISTERIAL HEALTH NETWORK NFP

Field Data
EIN 20-4535173
Case Number EO-2017031-000221
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHLAND MINISTERIAL HEALTH NETWORK NFP
Organization’s Mailing Address 15406 S LEXINGTON AVENUE
City HARVEY
State IL
ZIP 60426
Accounting period End 12
Primary contact name PAMELA WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARL WHITE
PRESIDENT
18761 CASTLE DARGAN DRIVE
COUNTRY CLUB HILLS IL 60478

Officer/Director/Trustee Two

CHARLES MICKENS
VICE PRESIDENT
26533 STEPHANIE COURT
MONEE IL 60449

Officer/Director/Trustee Three

ANGELA PAGE
SECRETARY
11609 SEMINOLE COURT
MOKENA IL 60448

Organization’s website
Organization’s email SMHN2901@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/28/2015
Organization Incorporation State IL
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: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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