FORM 1023-EZ for FERN FOUNDATION

Field Data
EIN 47-5173535
Case Number EO-2015279-000037
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FERN FOUNDATION
Organization’s Mailing Address 5666 IRIS COURT
City STANSBURY PARK
State UT
ZIP 84074
Accounting period End 12
Primary contact name LINDSAY HANSEN PARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LINDSAY PARK
DIRECTOR/PRESIDENT
5666 IRIS COURT
STANSBURY PARK UT 84074

Officer/Director/Trustee Two

GRACE POOL
DIRECTOR
343 NORTH THIRD WEST
SALT LAKE CITY UT 84103

Officer/Director/Trustee Three

DALLIN PARK
DIRECTOR/CFO
5666 IRIS COURT
STANSBURY PARK UT 84074

Officer/Director/Trustee Four

MARK PUGSLEY
DIRECTOR
36 STATE STREET SUITE 1400
SALT LAKE CITY UT 84111

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/25/2015
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A99 - Arts, Culture, and Humanities N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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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