FORM 1023-EZ for HEALTH POLICY FELLOWSHIP INITIATIVE

Field Data
EIN 47-1910117
Case Number EO-2017102-000154
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALTH POLICY FELLOWSHIP INITIATIVE
Organization’s Mailing Address 25 YALE COURT
City LIVINGSTON
State NJ
ZIP 07039
Accounting period End 12
Primary contact name KUSHYUP SHAH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RAVI SHAH
CHAIRMAN
25 YALE COURT
LIVINGSTON NJ 07039

Officer/Director/Trustee Two

KUSHYUP SHAH
TREASURER/SECRETARY
25 YALE COURT
LIVINGSTON NJ 07039

Officer/Director/Trustee Three

MEENA THATIKUNTA
VICE CHAIR
9462 HOPEWELL ROAD
CINCINNATI OH 45249

Officer/Director/Trustee Four

MISHAEL AZAM
DIRECTOR OF GOVERNMENT RELATIONS
212 DOUGLASS AVENUE
HADDONFIELD NJ 08033

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/30/2014
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B05 - Research Institutes and/or Public Policy Analysis
Organization’s purpose Charitable: Yes
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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