FORM 1023-EZ for FONDA EMERGENCY MEDICAL SERVICE ASSOCIATION

Field Data
EIN 86-1854854
Case Number EO-2021085-000386
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FONDA EMERGENCY MEDICAL SERVICE ASSOCIATION
Organization’s Mailing Address 104 W 2ND STREET
City FONDA
State IA
ZIP 50540
Accounting period End 12
Primary contact name NEVEN CONRAD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SANDY WELLS
PRESIDENT
801 QUEEN STREET
FONDA IA 50540-1018

Officer/Director/Trustee Two

LUANN KELLY
VICE-PRESIDENT
63063 CEDAR ROAD
FONDA IA 50540-1049

Officer/Director/Trustee Three

APRIL WADLE
SECRETARY
14215 610TH ST
FONDA IA 50540-8743

Officer/Director/Trustee Four

RICK WADLE
TREASURER
13687 620TH ST
FONDA IA 50540-8654

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2021
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M11 - Single Organization Support
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 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 SANDY WELLS
Signature Title PRESIDENT
Signature Date 2/3/2021

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