FORM 1023-EZ for ISABELA COMMUNITY HEALTH SERVICE CORP

Field Data
EIN 66-0834732
Case Number EO-2015173-000379
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ISABELA COMMUNITY HEALTH SERVICE CORP
Organization’s Mailing Address URB COSTA BRAVA M-295 FINCHE ST
City ISABELA
State PR
ZIP 00662
Accounting period End 12
Primary contact name ADRIAN GIRALD ROSA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ADRIAN GIRALD
PRESIDENT
USB COSTA BRAVE M-295 FINCHE ST
ISABELA PR 00662

Officer/Director/Trustee Two

CARLOS GUEVARA
VICE-PRESIDENT
8269 JOBOS AVE
ISABELA PR 00662

Officer/Director/Trustee Three

CYNTHIA FUENTES
SECRETARY/TREASURER
60 SAN CARLOS AVE SUITE 708
AGUADILLA PR 00603

Organization’s website
Organization’s email DRADRIAN2002@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/10/2002
Organization Incorporation State PR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 Yes
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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