FORM 1023-EZ for POSEYVILLE MEDICAL FOUNDATION INC

Field Data
EIN 47-4828307
Case Number EO-2015251-000217
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name POSEYVILLE MEDICAL FOUNDATION INC
Organization’s Mailing Address 38 W MAIN ST
City POSEYVILLE
State IN
ZIP 47633
Accounting period End 12
Primary contact name BRUCE BAKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOE REYNOLDS
PRESIDENT
9525 OAK HILL LANE
CYNTHIANA IN 47612

Officer/Director/Trustee Two

BRUCE BAKER
VICE PRESIDENT
220 WEST OAK ST
POSEYVILLE IN 47633

Officer/Director/Trustee Three

JULIE MAYO
TREASURER
76 WEST OAK ST
POSEYVILLE IN 47633

Officer/Director/Trustee Four

LYNDA BAKER
SECRETARY
220 WEST OAK ST
POSEYVILLE IN 47633

Officer/Director/Trustee Five

RICHARD MAIER
MEMBER
PO BOX 459
POSEYVILLE IN 47633

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/15/2015
Organization Incorporation State IN
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 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 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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