FORM 1023-EZ for HIMALAYAN MEDICAL FOUNDATION

Field Data
EIN 84-1244003
Case Number EO-2020230-000390
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HIMALAYAN MEDICAL FOUNDATION
Organization’s Mailing Address 608 PORTSIDE CT
City LAFAYETTE
State CO
ZIP 80026
Accounting period End 12
Primary contact name JAMES RABOLD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES RABOLD
MEDICAL DIRECTOR/ PRESIDENT
608 PORTSIDE CT
LAFAYETTE CO 80026

Officer/Director/Trustee Two

GISELA MATZKE
SECRETARY
608 PORTSIDE CT
LAFAYETTE CO 80026

Officer/Director/Trustee Three

BLAIR HANSON
TREASURER
990 HARTFORD DR
BOULDER CO 80305

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/30/1993
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JAMES RABOLD
Signature Title MEDICAL DIRECTOR/ PRESIDENT
Signature Date 8/13/2020

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