FORM 1023-EZ for TRI COUNTY HEALTH FITNESS

Field Data
EIN 83-0829214
Case Number EO-2018197-000555
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TRI COUNTY HEALTH FITNESS
Organization’s Mailing Address 301 WOOD STREET
City NEW BETHLEHEM
State PA
ZIP 16242
Accounting period End 12
Primary contact name AUSTIN BLOSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AUSTIN BLOSE
CFO/PRESIDENT
101 DOWNEY AVE
FARIMOUNT CITY PA 16242

Officer/Director/Trustee Two

MITCHELL BLOSE
CEO/VICE PRESIDENT
101 DOWNEY AVE
FAIRMOUNT CITY PA 16242

Organization’s website BLOSEBROTHERS.COM
Organization’s email BLOSEBROTHERSBUSINESS@BLOSEBROTHERS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/18
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: No
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 Yes
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 AUSTIN BLOSE
Signature Title CFO/PRESIDENT
Signature Date 7/14/18

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