| Field | Data |
|---|---|
| EIN | 83-1375195 |
| Case Number | EO-2019067-000543 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | GALLUP HEALTH COOPERATIVE |
| Organization’s Mailing Address | 600 E COAL AVE |
| City | GALLUP |
| State | NM |
| ZIP | 87301-6006 |
| Accounting period End | 8 |
| Primary contact name | SCOTT DANIEL BURGNER |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
SCOTT BURGNER
DIRECTOR
2297 HAWES AVE APT 1110
DALLAS TX 75235-4666
SAMANTHA BOONE
DIRECTOR
PO BOX 752
ZUNI NM 87327-752
SANDRA BURGNER
DIRECTOR
3561 BLACK OAK DR
ROCKLIN CA 95765
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/1/18 |
| Organization Incorporation State | NM |
| 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: Yes 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 | Yes |
| 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 | No |
| Correctness Declaration | Yes |
| Signature Name | SCOTT BURGNER |
| Signature Title | DIRECTOR |
| Signature Date | 3/6/19 |
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