FORM 1023-EZ for NATIONAL HEALTHCARE CERTIFICATION ASSOCIATION

Field Data
EIN 87-1045235
Case Number EO-2021179-000427
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NATIONAL HEALTHCARE CERTIFICATION ASSOCIATION
Organization’s Mailing Address 10808 S RIVER FRONT PKWY STE 3018
City SOUTH JORDAN
State UT
ZIP 84095
Accounting period End 12
Primary contact name DWAYNE VANCE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA MIGLIACCIO
TRUSTEE - EXEC DIRECTOR
10808 S RIVER FRONT PKWY STE 3018
SOUTH JORDAN UT 84095

Officer/Director/Trustee Two

MATT LONG
TRUSTEE - ASST DIRECTOR
10808 S RIVER FRONT PKWY STE 3018
SOUTH JORDAN UT 84095

Officer/Director/Trustee Three

RACHELLE HYMAS
TRUSTEE - SECRETARY
10808 S RIVER FRONT PKWY STE 3018
SOUTH JORDAN UT 84095

Organization’s website
Organization’s email BRIAN@HEALTHCARECERTIFICATIONS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/24/2021
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E03 - Professional Societies, Associations
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 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 ANDREA MIGLIACCIO
Signature Title TRUSTEE - EXEC DIRECTOR
Signature Date 6/24/2021

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