FORM 1023-EZ for PALM HARBOR ROTARY FOUNDATION
| Field | Data |
|---|---|
| EIN | 86-2778247 |
| Case Number | EO-2021099-001877 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | PALM HARBOR ROTARY FOUNDATION |
| Organization’s Mailing Address | PO BOX 515 |
| City | PALM HARBOR |
| State | FL |
| ZIP | 34683 |
| Accounting period End | 6 |
| Primary contact name | KELLY JEMISON |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
KELLY JEMISON
SECRETARY
2694 KAVALIER DR
PALM HARBOR FL 34684
Officer/Director/Trustee Two
GEORGE BOURIS
PRESIDENT
PO BOX 515
PALM HARBOR FL 34683
Officer/Director/Trustee Three
MARINA MANDIC
OFFICER
PO BOX 515
PALM HARBOR FL 34683
Officer/Director/Trustee Four
AMY VAN NESS
TREASURER
PO BOX 515
PALM HARBOR FL 34683
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | No |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/14/2021 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | W12 - Fund Raising and/or Fund Distribution |
| 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 | No |
| Seeking Section 7 Reinstatement | No |
| Correctness Declaration | Yes |
| Signature Name | KELLY JEMISON |
| Signature Title | SECRETARY |
| Signature Date | 3/22/2021 |
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