FORM 1023-EZ for PIECEWORKS OF FORT DODGE

Field Data
EIN 45-5353175
Case Number EO-2015189-000089
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PIECEWORKS OF FORT DODGE
Organization’s Mailing Address 22 SOUTH 3RD ST
City FORT DODGE
State IA
ZIP 50501
Accounting period End 12
Primary contact name BARBARA HUISMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KRIS CHRISTENSEN
PRESIDENT
302 8TH ST N
HUMBOLDT IA 50548

Officer/Director/Trustee Two

BARBARA HUISMAN
VICE-PRESIDENT
20186 SHERRI LANE
FORT DODGE IA 50501

Officer/Director/Trustee Three

JODIE TIETSORT
BOARD MEMBER
23863 BOIES ST
FORT DODGE IA 50501

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/11/2013
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural 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 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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