FORM 1023-EZ for WEST ALEXANDRIA EMERGENCY MEDICAL SERVICE

Field Data
EIN 31-1138197
Case Number EO-2017262-000168
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WEST ALEXANDRIA EMERGENCY MEDICAL SERVICE
Organization’s Mailing Address PO BOX 85
City WEST ALEXANDRIA
State OH
ZIP 45381
Accounting period End 12
Primary contact name THOMAS SMITH EMS CHIEF
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN DEVILBISS
PRESIDENT
PO BOX 85
WEST ALEXANDRIA OH 45381

Officer/Director/Trustee Two

THOMAS SMITH
VICE PRESIDENT
PO BOX 85
WEST ALEXANDRIA OH 45381

Officer/Director/Trustee Three

DIANA WALL
TREASURER
PO BOX 85
WEST ALEXANDRIA OH 45381

Officer/Director/Trustee Four

JAMIE POOL
SECRETARY
PO BOX 85
WEST ALEXANDRIA OH 45381

Organization’s website
Organization’s email TSMITH@WESTALEXEMS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/7/1984
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E62 - Ambulance, Emergency Medical Transport 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 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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