FORM 1023-EZ for LYDIAS HOUSE

Field Data
EIN 84-3529091
Case Number EO-2019326-000332
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LYDIAS HOUSE
Organization’s Mailing Address PO BOX 1317
City KEOKUK
State IA
ZIP 52632
Accounting period End 12
Primary contact name SUSAN SANDERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MATTHEW CAMPBELL
PRESIDENT
755 HICKORY TERRACE
KEOKUK IA 52632

Officer/Director/Trustee Two

SUSAN SANDERS
EXECUTIVE DIRECTOR
120 NORTH 19TH STREET
HAMILTON IL 62341

Officer/Director/Trustee Three

NILES PARN JR
TREASURER
136 WABASH AVE
CARTHAGE IL 62321

Officer/Director/Trustee Four

DEBORA HENTZEL
SECRETARY
2501 235TH STREET
FORT MADISON IA 52627

Organization’s website NA
Organization’s email SEW9915@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/21/19
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I71 - Spouse Abuse, Prevention of
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 SUSAN SANDERS
Signature Title EXECUTIVE DIRECTOR
Signature Date 11/20/19

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