FORM 1023-EZ for MEAD COMMUNITY FOOD BANK INC

Field Data
EIN 47-1835213
Case Number EO-2014274-000292
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MEAD COMMUNITY FOOD BANK INC
Organization’s Mailing Address PO BOX 404
City MEAD
State CO
ZIP 80542
Accounting period End 12
Primary contact name DIANE BACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DIANE BACK
PRESIDENT/MANAGER
212 GRAND VIEW CIR
MEAD CO 80542

Officer/Director/Trustee Two

LAREE SMITH
BOARD MEMBER
11708 BEASLY RD
LONGMONT CO 80504

Officer/Director/Trustee Three

NICK SEKICH
BOARD MEMBER
6790 CO RD 32
PLATTEVILLE CO 80651

Officer/Director/Trustee Four

BETTY WILL
SECRETARY/TREASURER
105 VIEW CT
MEAD CO 80542

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/15/2014
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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 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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