FORM 1023-EZ for PONDERA HEALTHCARE FOUNDATION

Field Data
EIN 30-0835985
Case Number EO-2014293-000096
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PONDERA HEALTHCARE FOUNDATION
Organization’s Mailing Address PO BOX 802
City CONRAD
State MT
ZIP 59425-0802
Accounting period End 12
Primary contact name KRISTEN JURAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DONALD MCCLAIN
DIRECTOR, PRESIDENT
13 WISCONSIN ST SOUTH
CONRAD MT 59425

Officer/Director/Trustee Two

GARY OLSON
DIRECTOR, VICE PRESIDENT
1008 SUNSET BLVD
CONRAD MT 59425

Officer/Director/Trustee Three

TERRY AAKRE
DIRECTOR, TREASURER
509 S ILLINOIS
CONRAD MT 59425

Officer/Director/Trustee Four

KRISTEN JURAS
DIRECTOR, SECRETARY
220 WOODLAND ESTATES RD
GREAT FALLS MT 59404

Officer/Director/Trustee Five

DEDE BROWN
DIRECTOR
629 PRAIRIE VIEW RD
CONRAD MT 59425

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/2014
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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 Yes
One Third Support Gifts No
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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