FORM 1023-EZ for PREMIER VALLEY HEALTHCARE

Field Data
EIN 87-2281264
Case Number EO-2021258-000404
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PREMIER VALLEY HEALTHCARE
Organization’s Mailing Address 4650 N PALM AVE
City FRESNO
State CA
ZIP 93704
Accounting period End 12
Primary contact name TASNEEM CHAUDHRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TASNEEM CHAUDHRY
PRESIDENT AND CFO
4650 N PALM AVE
FRESNO CA 93704

Officer/Director/Trustee Two

MUHAMMAD CHAUDHRY
SECRETARY
4650 N PALM AVE
FRESNO CA 93704

Officer/Director/Trustee Three

SONYA GAGE
DIRECTOR
4650 N PALM AVE
FRESNO CA 93704

Officer/Director/Trustee Four

JONATHAN CLAGUE
DIRECTOR
4650 N PALM AVE
FRESNO CA 93704

Officer/Director/Trustee Five

TIMOTHY JURKOWSKI
DIRECTOR
4650 N PALM AVE
FRESNO CA 93704

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/17/2021
Organization Incorporation State CA
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: 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 Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 TASNEEM CHAUDHRY
Signature Title PRESIDENT AND CFO
Signature Date 9/14/2021

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