FORM 1023-EZ for CORNERSTONE LIFE FOUNDATION INC

Field Data
EIN 30-0035644
Case Number EO-2015244-000193
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CORNERSTONE LIFE FOUNDATION INC
Organization’s Mailing Address PO BOX 94
City RED OAK
State IA
ZIP 51566
Accounting period End 12
Primary contact name ALAN DEAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ALAN DEAN
BOARD PRESIDENT-DIRECTOR
1201 N 6TH STREET
RED OAK IA 51566

Officer/Director/Trustee Two

PEG BAIER
BOARD TREASURER-DIRECTOR
623 SUNSET DRIVE
CLARINDA IA 51632

Officer/Director/Trustee Three

RICKY ROHRIG SR
EXECUTIVE DIRECTOR-OFFICER
211 E VALLEY STREET
RED OAK IA 51566

Officer/Director/Trustee Four

ROD GOODEMOTE
DIRECTOR
112 N 3RD AVENUE
VILLISCA IA 50864

Officer/Director/Trustee Five

CARYN PEDERSEN
DIRECTOR
1102 E COOLBAUGH STREET
RED OAK IA 51566

Organization’s website WWW.PCSI.CARE
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/19/2001
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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