FORM 1023-EZ for EASTERN KENTUCKY HEALTHCARE CONSORTIUM INC

Field Data
EIN 82-4080135
Case Number EO-2018039-000063
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EASTERN KENTUCKY HEALTHCARE CONSORTIUM INC
Organization’s Mailing Address PO BOX 626
City FLATWOODS
State KY
ZIP 41139
Accounting period End 12
Primary contact name JAMES DIETZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MIKE ROBERTS
DIRECTOR
5000 KY STATE ROUTE 321
PRESTONSBURG KY 41653-8304

Officer/Director/Trustee Two

ANDY PRICE
DIRECTOR
222 MEDICAL CIRCLE
MOREHEAD KY 40351-9587

Officer/Director/Trustee Three

NICK CHINN
DIRECTOR
2900 FIRST AVENUE
ASHLAND KY 25702-1241

Officer/Director/Trustee Four

BRIAN RODEHAVER
DIRECTOR
1000 ST CHRISTOPHER DRIVE
ASHLAND KY 41101-7034

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/18/18
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 Yes
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 MIKE ROBERTS
Signature Title DIRECTOR
Signature Date 2/6/18

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