FORM 1023-EZ for FAYETTE COUNTY COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP INC

Field Data
EIN 30-0118917
Case Number EO-2016011-000352
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FAYETTE COUNTY COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP INC
Organization’s Mailing Address 2054 SPRINGHILL FURNACE ROAD
City SMITHFIELD
State PA
ZIP 15478
Accounting period End 6
Primary contact name SANDRA MORRIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN RAPANO
CHAIR
4 WINDRIDGE DRIVE
UNIONTOWN PA 15401

Officer/Director/Trustee Two

SANDY THORPE
VICE CHAIR
500 W BERKELEY ST
UNIONTOWN PA 15401

Officer/Director/Trustee Three

JIM STARK
TREASURER
136 N BEESON AVE
UNIONTOWN PA 15401

Officer/Director/Trustee Four

SANDRA MORRIS
SECRETARY
48 BIERER LANE
UNIONTOWN PA 15401

Officer/Director/Trustee Five

GINA DAURIA
DIRECTOR
130 OLD NEW SALEM ROAD
UNIONTOWN PA 15401

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/16/2001
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion 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 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 No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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