FORM 1023-EZ for NEBRASKA INFERTILITY FOUNDATION

Field Data
EIN 86-1289916
Case Number EO-2021119-000299
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NEBRASKA INFERTILITY FOUNDATION
Organization’s Mailing Address 87672 518 AVE
City VERDIGRE
State NE
ZIP 68783
Accounting period End 12
Primary contact name KELSY JELINEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELSY JELINEK
PRESIDENT
87672 518 AVE
VERDIGRE NE 68783-6034

Officer/Director/Trustee Two

BRIANA WILCOX
VICE PRESIDENT
306 LONGWOOD DR
PAPILLION NE 68133-3385

Officer/Director/Trustee Three

MELISSA FULLNER-MARSHALL
BOARD MEMBER
PO BOX 287
CREIGHTON NE 68729-0287

Officer/Director/Trustee Four

KEITH VRBICKY
BOARD MEMBER
500 WILLIAMS ST
NORFOLK NE 68701-3439

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2021
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G12 - 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 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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KELSY JELINEK
Signature Title PRESIDENT
Signature Date 4/27/2021

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