FORM 1023-EZ for AUSTIN EMERGENCY MEDICINE FOUNDATION
| Field | Data |
|---|---|
| EIN | 84-2119641 |
| Case Number | EO-2019288-000587 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | AUSTIN EMERGENCY MEDICINE FOUNDATION |
| Organization’s Mailing Address | 1400 N I-35 SUITE 2-230 |
| City | AUSTIN |
| State | TX |
| ZIP | 78701 |
| Accounting period End | 12 |
| Primary contact name | BROOKE WATANABE MD |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
BROOKE WATANABE MD
DIRECTOR
2906 KUHLMAN AVE
AUSTIN TX 78702
Officer/Director/Trustee Two
MARIA DINH VUONG MD
DIRECTOR
7607 TUSSENDO DR
HOUSTON TX 77083
Officer/Director/Trustee Three
ANDREA HERNSBERGER MD
DIRECTOR
432 N WASHINGTON AVE
FAYETTEVILLE AR 72701
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 6/13/19 |
| Organization Incorporation State | TX |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B84 - Alumni Associations |
| 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 | 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 | BROOKE WATANABE MD |
| Signature Title | DIRECTOR |
| Signature Date | 10/13/19 |
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