FORM 1023-EZ for THRIVE NON-PROFIT FAMILY MEDICAL CENTER

Field Data
EIN 85-4172650
Case Number EO-2021027-000339
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THRIVE NON-PROFIT FAMILY MEDICAL CENTER
Organization’s Mailing Address 100 N WATER ST
City HENDERSON
State KY
ZIP 42420
Accounting period End 11
Primary contact name REBECCA D HOPPER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REBECCA HOPPER
MD
14137 US 41 A
CORYDON KY 42406

Officer/Director/Trustee Two

JENNIFER LILES
MD
110 NORTH WATER ST
HENDERSON KY 42420

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/18/2020
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name REBECCA HOPPER
Signature Title MD
Signature Date 12/7/2020

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