FORM 1023-EZ for PUBLIC HEALTH FOUNDATION
| Field | Data |
|---|---|
| EIN | 82-2756302 |
| Case Number | EO-2017261-000315 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | PUBLIC HEALTH FOUNDATION |
| Organization’s Mailing Address | 723 1ST AVE S |
| City | FORT DODGE |
| State | IA |
| ZIP | 50501 |
| Accounting period End | 12 |
| Primary contact name | KARI PRESCOTT |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
KARI PRESCOTT
CHAIRMAN
723 1ST AVE S
FORT DODGE IA 50501
Officer/Director/Trustee Two
LINDA OPHEIM
MEMBER
723 1ST AVE S
FORT DODGE IA 50501
Officer/Director/Trustee Three
MARK CAMPBELL
MEMBER
723 1ST AVE S
FORT DODGE IA 50501
Officer/Director/Trustee Four
JOHN DENCKLAU
MEMBER
723 1ST AVE S
FORT DODGE IA 50501
Officer/Director/Trustee Five
DR KELLI WALLACE
MEMBER
723 1ST AVE S
FORT DODGE IA 50501
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/23/2016 |
| Organization Incorporation State | IA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E70 - Public Health Program (Includes General Health and Wellness Promotion Services) |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes 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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