FORM 1023-EZ for BELLOWS COMMUNITY ALLIANCE

Field Data
EIN 81-1447530
Case Number EO-2016048-000262
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BELLOWS COMMUNITY ALLIANCE
Organization’s Mailing Address 505 NORTH 39TH STREET
City COUNCIL BLUFFS
State IA
ZIP 51501-1716
Accounting period End 12
Primary contact name MELISSA LASSEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MELISSA LASSEK
DIRECTOR
1321 21ST AVE
COUNCIL BLUFFS IA 51501-7237

Officer/Director/Trustee Two

JOSHUA BELLOWS
DIRECTOR
505 NORTH 39TH ST
COUNCIL BLUFFS IA 51501-1716

Officer/Director/Trustee Three

MATTHEW WOBBEMA
DIRECTOR
1319 N 21ST ST
COUNCIL BLUFFS IA 51501-0910

Officer/Director/Trustee Four

TERRY PRUITT
DIRECTOR
1719 AVE C
COUNCIL BLUFFS IA 51501-2441

Organization’s website BCA-CB.ORG
Organization’s email BCA-CB@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/18/2016
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
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 Yes
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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