FORM 1023-EZ for WAUKON EMS ASSOCIATION INC

Field Data
EIN 84-2738616
Case Number EO-2019241-000194
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WAUKON EMS ASSOCIATION INC
Organization’s Mailing Address 565 11TH AVE SW
City WAUKON
State IA
ZIP 52172
Accounting period End 12
Primary contact name DAVID E MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID MARTIN
PRESIDENT/DIRECTOR
565 11TH AVE SW
WAUKON IA 52172

Officer/Director/Trustee Two

CHERYL LIVINGSTON
SECRETARY/DIRECTOR
565 11TH AVE SW
WAUKON IA 52172

Officer/Director/Trustee Three

DOMINICK MELLICK
DIRECTOR
565 11TH AVE SW
WAUKON IA 52172

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/9/19
Organization Incorporation State IA
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 DAVID MARTIN
Signature Title PRESIDENT/DIRECTOR
Signature Date 8/27/19

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