FORM 1023-EZ for MICHIANA INSTITUTE FOR SUCCESSFUL AGING
| Field | Data |
|---|---|
| EIN | 82-3314834 |
| Case Number | EO-2018045-000138 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | MICHIANA INSTITUTE FOR SUCCESSFUL AGING |
| Organization’s Mailing Address | 22133 SILVER SPRINGS DR |
| City | SOUTH BEND |
| State | IN |
| ZIP | 46628-9718 |
| Accounting period End | 12 |
| Primary contact name | JOSEPH CIBA |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JOSH WALKER
CHAIR OF THE BOARD
3003 COLONIAL DR
MISHAWAKA IN 46544
Officer/Director/Trustee Two
STEPHANIE LISENKO
PRESIDENT
22133 SILVER SPRINGS DR
SOUTH BEND IN 46628-9718
Officer/Director/Trustee Three
JENNIFER ANDREWS
VICE PRESIDENT
1147 SOUTH THIRD ST
NILES MI 49120
Officer/Director/Trustee Four
MEGAN NOLL
SECRETARY
1211 STATE LINE RD
NILES MI 49120
Officer/Director/Trustee Five
JOSEPH CIBA
TREASURER
17770 TANAGER LANE
SOUTH BEND IN 46635-1317
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/13/17 |
| Organization Incorporation State | IN |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B01 - Alliance/Advocacy Organizations |
| 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 | 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 | JOSEPH CIBA |
| Signature Title | TREASURER |
| Signature Date | 2/12/18 |
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