FORM 1023-EZ for JACKSON COUNTY EMS ASSOCIATION

Field Data
EIN 86-1885531
Case Number EO-2021099-001197
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACKSON COUNTY EMS ASSOCIATION
Organization’s Mailing Address 201 W PLATT ST
City MAQUOKETA
State IA
ZIP 52060-2243
Accounting period End 12
Primary contact name MICHAEL STURM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL STURM
PRESIDENT
804 BROADWAY ST
BELLEVUE IA 52031-9446

Officer/Director/Trustee Two

TRAVIS CAPESIUS
SECRETARY
37866 230TH AVE
LAMOTTE IA 52054-9507

Officer/Director/Trustee Three

VICKI JOHNSON
TREASURER
549 GRANT ST
MILES IA 51064-4411

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/2021
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E62 - Ambulance, Emergency Medical Transport Services
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 MICHAEL STURM
Signature Title PRESIDENT
Signature Date 3/19/2021

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