FORM 1023-EZ for ADOPT A NURSING HOME PATIENT INC

Field Data
EIN 47-5305905
Case Number EO-2015338-000129
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ADOPT A NURSING HOME PATIENT INC
Organization’s Mailing Address 31 OAKLAND
City IRVINGTON
State NJ
ZIP 07111
Accounting period End 12
Primary contact name CARLOS F FRASER EA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROSIE HORNER
EX. DIRECTOR
31 OAKLAND ST
IRVINGTON NJ 07111

Officer/Director/Trustee Two

LISA PALMER
CHAIRPERSON
480 HENRY STREET
ELIZABETH NJ 07201

Officer/Director/Trustee Three

MAMIE FLOUNOY
SECRETARY
154 TUXEDO PARKWAY
NEWARK NJ 07106

Officer/Director/Trustee Four

SANDRA THOMAS
TREASURER
617 THOMAS STREET APT A
ORANGE NJ 07050

Organization’s website ADOPTANURSINGHOMEPATIENT.COM
Organization’s email
Organization Incorporated
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/21/2015
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A01 - 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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