FORM 1023-EZ for COMMUNITY HEALTHCARE RESOURCES

Field Data
EIN 85-3604376
Case Number EO-2020301-000120
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY HEALTHCARE RESOURCES
Organization’s Mailing Address 2550 MIDDLE RD 400
City BETTENDORF
State IA
ZIP 52722
Accounting period End 12
Primary contact name DAVID M CIASTO CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAY JOHANNSEN
PRESIDENT
2550 MIDDLE RD 400
BETTENDORF IA 52722

Officer/Director/Trustee Two

ZACHARY MULLIN
DIRECTOR
1215 HILLSIDE DR
BETTENDORF IA 52722

Officer/Director/Trustee Three

LAURA PRICE
DIRECTOR
2550 MIDDLE RD 400
BETTENDORF IA 52722

Organization’s website
Organization’s email david@cpadave.com
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/23/2020
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E21 - Community Health Systems
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 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 No
Correctness Declaration Yes
Signature Name JAY JOHANNSEN
Signature Title PRESIDENT
Signature Date 10/23/2020

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