FORM 1023-EZ for SIOUX UNION MISSIONARY HOME

Field Data
EIN 81-0772180
Case Number EO-2016006-000264
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SIOUX UNION MISSIONARY HOME
Organization’s Mailing Address 612 8TH ST SE
City ORANGE CITY
State IA
ZIP 51041
Accounting period End 12
Primary contact name KATHY DEKOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARGE VAN DRIEL
PRESIDENT
208 ELM ST
IRETON IA 51027

Officer/Director/Trustee Two

BONNIE KAERICHER
SECRETARY
202 ARIZONA AVE NW
ORANGE CITY IA 51041

Officer/Director/Trustee Three

LEEANN SMIT
TREASURER
902 SECOND ST SE
ORANGE CITY IA 51041

Officer/Director/Trustee Four

FRAN KOETS
HOME OVERSIGHT
104 FLORIDA AVE SW
ORANGE CITY IA 51041

Officer/Director/Trustee Five

KATHY DEKOCK
MEMBER AT LARGE
113 SD HWY 11
ALCESTER SD 57001

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/5/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X21 - Protestant
Organization’s purpose Charitable: Yes
Religious: Yes
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
Signature Title
Signature Date

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