FORM 1023-EZ for TC PHYSICIANS CHARITY

Field Data
EIN 82-2684769
Case Number EO-2017250-000310
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TC PHYSICIANS CHARITY
Organization’s Mailing Address PO BOX 490
City TUBA CITY
State AZ
ZIP 86045
Accounting period End 12
Primary contact name WILEY THUET
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILEY THUET
PRESIDENT, DIRECTOR
483 EAST ELM CIRCLE
TUBA CITY AZ 86045

Officer/Director/Trustee Two

ZACHARY STAMILE
DIRECTOR
100 WEST QUARTZ ROAD
FLAGSTAFF AZ 86005

Officer/Director/Trustee Three

KENNETH BERNARD
DIRECTOR
3928 SOUTH AMERICA WEST TRAIL
FLAGSTAFF AZ 86005

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/2017
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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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