FORM 1023-EZ for COON RAPIDS EMS ASSOCIATION

Field Data
EIN 46-4052986
Case Number EO-2015282-000394
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COON RAPIDS EMS ASSOCIATION
Organization’s Mailing Address 412 PARK ST
City COON RAPIDS
State IA
ZIP 50058
Accounting period End 12
Primary contact name JOSH SMOUSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RYAN BASS
DIRECTOR
105 WOODLAND DR
COON RAPIDS IA 50058

Officer/Director/Trustee Two

TAMMY ROETMAN
DIRECTOR
30435 335TH ST
COON RAPIDS IA 50058

Officer/Director/Trustee Three

PAULETTE MCDONOUGH
DIRECTOR
32779 335TH ST
COON RAPIDS IA 50058

Officer/Director/Trustee Four

SARAH HART
DIRECTOR
123 320TH ST
COON RAPIDS IA 50058

Officer/Director/Trustee Five

NATALIE LEWIS
DIRECTOR
523 MAIN ST
COON RAPIDS IA 50058

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/17/2013
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E62 - Ambulance, Emergency Medical Transport 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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