FORM 1023-EZ for RURAL HEALTH AND SAFETY CLINIC OF GREATER JOHNSON COUNTY

Field Data
EIN 45-4577065
Case Number EO-2017117-000382
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RURAL HEALTH AND SAFETY CLINIC OF GREATER JOHNSON COUNTY
Organization’s Mailing Address 3109 OLD HIGHWAY 218 S
City IOWA CITY
State IA
ZIP 52246-5812
Accounting period End 12
Primary contact name RUSSELL MEADE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROGER STUTSMAN
PRESIDENT
3714 500TH SW
RIVERSIDE IA 52327

Officer/Director/Trustee Two

LINDA YODER
SECRETARY
2421 160TH ST
MARENGO IA 52301

Officer/Director/Trustee Three

NYLE KAUFFMAN
TREASURER
2460 TOWNCREST DRIVE
IOWA CITY IA 52240

Officer/Director/Trustee Four

RUSSELL MEADE
DIRECTOR
3522 HALF MOON AVE SW
TIFFIN IA 52340-9337

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/23/2014
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M40 - Safety Education
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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