FORM 1023-EZ for WESTERN AMERICAN CORRECTIONAL HEALTH SERVICES ASSOCIATION

Field Data
EIN 61-1849316
Case Number EO-2017194-000391
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WESTERN AMERICAN CORRECTIONAL HEALTH SERVICES ASSOCIATION
Organization’s Mailing Address PO BOX 3013
City SANTA ROSA
State CA
ZIP 95402
Accounting period End 12
Primary contact name KATHY SNELSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALEXANDER CHYORNY
PRESIDENT
PO BOX 3013
SANTA ROSA CA 95402

Officer/Director/Trustee Two

PAUL ADLER
PRESIDENT-ELECT
PO BOX 3013
SANTA ROSA CA 95402

Officer/Director/Trustee Three

PAULETTE FINANDER
SECRETARY
PO BOX 3013
SANTA ROSA CA 95402

Officer/Director/Trustee Four

SAM ROSALES
TREASURER
PO BOX 3013
SANTA ROSA CA 95402

Organization’s website STATEPEN.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/24/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B03 - 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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