FORM 1023-EZ for COMMUNITY MEDICAL CENTER FOUNDATION

Field Data
EIN 46-3491851
Case Number EO-2015142-000514
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COMMUNITY MEDICAL CENTER FOUNDATION
Organization’s Mailing Address 3307 BARADA STREET
City FALLS CITY
State NE
ZIP 68355
Accounting period End 7
Primary contact name SCOTT SAWYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RODGER MERZ
CHAIR
65257 715 ROAD
FALLS CITY NE 68355

Officer/Director/Trustee Two

MARSHA BRENNAN
VICE-CHAIR
66300 703 LANE
RULO NE 68431

Officer/Director/Trustee Three

BOB AITKEN
SECRETARY/TREASURER
1418 NEMAHA AVENUE
FALLS CITY NE 68355

Officer/Director/Trustee Four

RYAN LARSEN
DIRECTOR
2602 SCHOENHEIT
FALLS CITY NE 68355

Officer/Director/Trustee Five

SCOTT SAWYER
DIRECTOR
2110 CHASE STREET
FALLS CITY NE 68355

Organization’s website
Organization’s email FOUNDATION@CMCFC.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/20/2012
Organization Incorporation State NE
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 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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