FORM 1023-EZ for HEALTH RESEARCH INSTITUTE

Field Data
EIN 47-5550533
Case Number EO-2015335-000175
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HEALTH RESEARCH INSTITUTE
Organization’s Mailing Address PO BOX 1995
City FAIRFIELD
State IA
ZIP 52256
Accounting period End 1
Primary contact name LARRY BOHLEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN FAGAN
PRESIDENT
103 FULL MOON LANE
FAIRFIELD IA 52556

Officer/Director/Trustee Two

LARRY BOHLEN
SECRETARY TREASURER
20 CLARKS LANE
REISTERTOWN MD 21136

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K99 - Food, Agriculture, and Nutrition N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
Literary: No
Public Safety: Yes
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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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