FORM 1023-EZ for SAMARITAN HOSPITAL AUXILLARY

Field Data
EIN 81-4297149
Case Number EO-2016312-000550
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAMARITAN HOSPITAL AUXILLARY
Organization’s Mailing Address 1205 N MISSOURI STREET
City MACON
State MO
ZIP 63552
Accounting period End 12
Primary contact name BARBARA WILT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHERYL BLAISE
PRESIDENT
905 WALNUT ST
MACON MO 63552

Officer/Director/Trustee Two

MARILYN STROPPLE
VICE PRESIDENT
1005 SUNSET
MACON MO 63552

Officer/Director/Trustee Three

IRENE WATTS
SECRETARY
35197 HWY C
BEVIER MO 63532

Officer/Director/Trustee Four

BARBARA WILT
TREASURER
1403 SUNRISE POINTE
MACON MO 63552

Organization’s website
Organization’s email YBARB1@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/14/2016
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A11 - Single Organization Support
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 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
Signature Title
Signature Date

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