FORM 1023-EZ for LIFESTAR RURAL EMS SOLUTIONS

Field Data
EIN 84-3841665
Case Number EO-2020210-000886
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIFESTAR RURAL EMS SOLUTIONS
Organization’s Mailing Address 3 PUMP HOUSE RD
City GARDEN VALLEY
State ID
ZIP 83622-5059
Accounting period End 12
Primary contact name WILLIAM PAINE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM PAINE
DIRECTOR
3 PUMP HOUSE RD
GARDEN VALLEY ID 83622-5059

Officer/Director/Trustee Two

MICHAEL KISH
DIRECTOR
3873 S ARNO AVE
MERIDIAN ID 83642-1237

Organization’s website WWW.LIFESTARRURALEMS.ORG
Organization’s email LIFESTAREMS@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/18/2018
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E62 - Ambulance, Emergency Medical Transport Services
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 WILLIAM PAINE
Signature Title DIRECTOR
Signature Date 7/26/2020

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