FORM 1023-EZ for HEALTHY HARRISON INCORPORATED

Field Data
EIN 81-1575812
Case Number EO-2017179-000243
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALTHY HARRISON INCORPORATED
Organization’s Mailing Address 227 MEDICAL PARK DR
City BRIDGEPORT
State WV
ZIP 26330
Accounting period End 12
Primary contact name JOHN PAUL NARDELLI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BROCK MALCOLM
PRESIDENT
227 MEDICAL PARK DR
BRIDGEPORT WI 26330

Officer/Director/Trustee Two

MIKE TILLMAN
TREASURER
227 MEDICAL PARK DR
BRIDGEPORT WV 26330

Officer/Director/Trustee Three

ML QUINN
VICE PRESIDENT
227 MEDICAL PARK DR
BRIDGEPORT WV 26330

Officer/Director/Trustee Four

ELIZABETH SHAHAN
SECRETARY
227 MEDICAL PARK DR
BRIDGEPORT WV 26330

Officer/Director/Trustee Five

JOHN PAUL NARDELLI
DIRECTOR
227 MEDICAL PARK DR
BRIDGEPORT WV 26330

Organization’s website HTTP://WWW.HEALTHYHARRISON.ORG
Organization’s email JOHN.NARDELLI@WVUMEDICINE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2016
Organization Incorporation State WV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W24 - Citizen Participation
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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