FORM 1023-EZ for TOMBALL REGIONAL MEDICAL STAFF FUNDINC

Field Data
EIN 47-5496185
Case Number EO-2015310-000305
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TOMBALL REGIONAL MEDICAL STAFF FUNDINC
Organization’s Mailing Address 605 HOLDERRIETH BLVD
City TOMBALL
State TX
ZIP 77375-6445
Accounting period End 12
Primary contact name RON HAFFNER CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LANCE FERAY
TREASURER
720 LAWRENCE
TOMBALL TX 78013

Officer/Director/Trustee Two

DAVID WILLS
CHIEF OF STAFF
4545 POST OAK PLACE DR STE 130
HOUSTON TX 77027

Officer/Director/Trustee Three

ADNAN ASLAM
EX CHIEF OF STAFF
308 HOLDERRIETH
TOMBALL TX 78013

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/31/2015
Organization Incorporation State TX
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 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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