FORM 1023-EZ for PUEBLO SAFETY AND HEALTH ADMINISTRATION

Field Data
EIN 47-1090126
Case Number EO-2016327-000185
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PUEBLO SAFETY AND HEALTH ADMINISTRATION
Organization’s Mailing Address 900 WEST ORMAN AVENUE
City PUEBLO
State CO
ZIP 81004-1499
Accounting period End 12
Primary contact name AMANDA CORUM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN KONCILJA
PRESIDENT
4112 OUTLOOK BLVD
PUEBLO CO 81008-1667

Officer/Director/Trustee Two

ED PASIC
VICE PRESIDENT
250 WILLIAM WHITE BLVD
PUEBLO CO 81001-4838

Officer/Director/Trustee Three

KATHERINE COX
TREASURER
900 WEST ORMAN AVENUE
PUEBLO CO 81004-1499

Officer/Director/Trustee Four

AMANDA CORUM
SECRETARY
900 WEST ORMAN AVENUE
PUEBLO CO 81004-1499

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/23/2007
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M01 - Alliance/Advocacy Organizations
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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