FORM 1023-EZ for MITAKUYE OYASIN

Field Data
EIN 45-3939553
Case Number EO-2015106-000193
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MITAKUYE OYASIN
Organization’s Mailing Address 1005 SOUTH Y STREET
City INDIANOLA
State IA
ZIP 50125
Accounting period End 12
Primary contact name ANDREA JIMMERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANDREA JIMMERSON
PRESIDENT
1005 SOUTH Y STREET
INDIANOLA IA 50125

Officer/Director/Trustee Two

TIFFANY RUCH
SECRETARY/TREASURER
212 11TH AVENUE SW
ALTOONA IA 50009

Officer/Director/Trustee Three

KYLIE GUDENKAUF
DIRECTOR
307 TAMA STREET
SLATER IA 50244

Officer/Director/Trustee Four

ASHLEY HILSABECK
DIRECTOR
7655 ADAMS STREET APT 2
FOREST PARK IL 50130

Officer/Director/Trustee Five

MEGAN HULBERT
DIRECTOR
1604 W 2ND STREET
OTTUMWA IA 52501

Organization’s website WWW.MITAKUYEO.ORG
Organization’s email MITAKUYEOYASINNONPROFIT@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/25/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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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