FORM 1023-EZ for NORTH DAKOTA PUBLIC HEALTH ASSOCIATION

Field Data
EIN 45-0441068
Case Number EO-2018225-000390
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTH DAKOTA PUBLIC HEALTH ASSOCIATION
Organization’s Mailing Address PO BOX 7282
City BISMARCK
State ND
ZIP 58507-7282
Accounting period End 12
Primary contact name RENAE MOCH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHERRY ADAMS
PRESIDENT
2869 3RD AVE WEST
DICKINSON ND 58601

Officer/Director/Trustee Two

RENAE MOCH
PRESIDENT ELECT/CO-TREASURER
120 KEIDEL TRAIL SW
MANDAN ND 58554

Officer/Director/Trustee Three

SUSAN KAHLER
VICE PRESIDENT/CO-TREASURER
611 8TH AVE NW
MANDAN ND 58554

Officer/Director/Trustee Four

JEANNA KUJAVA
SECRETARY
PO BOX 102
HALLOCK MN 56728-102

Organization’s website WWW.NDPHA.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/7/97
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: No
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 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 RENAE MOCH
Signature Title PRESIDENT ELECT/CO-TREASURER
Signature Date 8/10/18

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