FORM 1023-EZ for CENTRAL IOWA EMERGENCY SERVICES CHAPLAINCY INCORPORATED

Field Data
EIN 46-3235506
Case Number EO-2015016-000086
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CENTRAL IOWA EMERGENCY SERVICES CHAPLAINCY INCORPORATED
Organization’s Mailing Address 1609 WOODHAVEN CIRCLE
City AMES
State IA
ZIP 50036
Accounting period End 6
Primary contact name JACK OWENS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JACK OWENS
PRESIDENT
2214 PINEHURST DRIVE
AMES IA 50014

Officer/Director/Trustee Two

ROD SIMPSON
VICE PRESIDENT
57606 US HWY 30
AMES IA 50010

Officer/Director/Trustee Three

DAN BRANDT
SECRETARY
PO BOX 1003
MARSHALLTOWN IA 50158

Officer/Director/Trustee Four

RICHARD REYNOLDS
TREASURER
1128 BOONE STREET
BOONE IA 50036

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/17/2013
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 Yes
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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