FORM 1023-EZ for ALLUMINE HEALTH FOUNDATION

Field Data
EIN 84-3114949
Case Number EO-2020052-000258
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ALLUMINE HEALTH FOUNDATION
Organization’s Mailing Address 4030 STATE HWY 6 S STE 101
City COLLEGE STATION
State TX
ZIP 77845-1802
Accounting period End 12
Primary contact name CARLOS HERNANDEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANA ROWSE
PRESIDENT
704 PUTTER CT
COLLEGE STATION TX 77845-1802

Officer/Director/Trustee Two

POLLACHI SELVAKUMARRAJ
SECRETARY
4050 SWEETWATER DR
COLLEGE STATION TX 77845-1802

Officer/Director/Trustee Three

CARLOS HERNANDEZ
VICE PRESIDENT
2426 STONE CASTLE CIRCLE
COLLEGE STATION TX 77845-1802

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/13/2019
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P74 - Hospice
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CARLOS HERNANDEZ
Signature Title VICE PRESIDENT
Signature Date 2/19/2020

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