FORM 1023-EZ for INTERNATIONAL HEALTH SYSTEMS USA

Field Data
EIN 81-1857509
Case Number EO-2016356-000116
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name INTERNATIONAL HEALTH SYSTEMS USA
Organization’s Mailing Address 3261 19TH ST NW
City ROCHESTER
State MN
ZIP 55901
Accounting period End 12
Primary contact name CARMEN PLESCHOURT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DR ADERONKE MORDI
PRESIDENT
3261 19TH ST NW
ROCHESTER MN 55901

Officer/Director/Trustee Two

MICHAEL MORDI
VICE PRESIDENT
3261 19TH ST NW
ROCHESTER MN 55901

Officer/Director/Trustee Three

ADEBOYE FAJINMI
BOARD MEMBER
3261 19TH ST NW
ROCHESTER MN 55901

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/17/2016
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 Yes
Financial transactions with officers Yes
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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