FORM 1023-EZ for FRIENDS OF MALIA CHILDRENS HOME - USA INC

Field Data
EIN 47-2129774
Case Number EO-2014307-000389
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FRIENDS OF MALIA CHILDRENS HOME - USA INC
Organization’s Mailing Address 731 COLUMBIA RD
City FORT COLLINS
State CO
ZIP 80525-1835
Accounting period End 6
Primary contact name JOHN NYSTROM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN NYSTROM
PRESIDENT - CHAIRPERSON
731 COLUMBIA RD
FORT COLLINS CO 80525-1835

Officer/Director/Trustee Two

THOMAS NDOLO
TREASURER
4940 WESTRIDGE
FORT COLLINS CO 80526-8052

Officer/Director/Trustee Three

VINCENT MUTAMBUKI
VICE-PRESIDENT
2420 SOUTHLAWN DR
DES MOINES IA 50320-2736

Officer/Director/Trustee Four

KAREN NYSTROM
SECRETARY
731 COLUMBIA RD
FORT COLLINS CO 80525-1835

Officer/Director/Trustee Five

JOAN CHAPMAN-SMITH
DIRECTOR
1416 PIKES PEAK AVE
FORT COLLINS CO 80525-4314

Organization’s website
Organization’s email JKN1221@Q.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/20/2014
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
Organization’s purpose Charitable: Yes
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 No
Conducting Activities Outside of United States Yes
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
Signature Title
Signature Date

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