FORM 1023-EZ for NAMI NORTHEAST IOWA

Field Data
EIN 81-0746807
Case Number EO-2015357-000224
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NAMI NORTHEAST IOWA
Organization’s Mailing Address 119 WINNEBAGO STREET SUITE 4
City DECORAH
State IA
ZIP 52101
Accounting period End 12
Primary contact name ALICIA TROUT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT CARBONELL
BOARD PRESIDENT
603 COLLEGE DRIVE APT 1
DECORAH IA 52101

Officer/Director/Trustee Two

ALICIA TROUT
BOARD TREASURER
1387 COON CREEK ROAD
DECORAH IA 52101

Officer/Director/Trustee Three

BRITA CARBONELL
BOARD VICE PRESIDENT
403 JOHN STREET
DECORAH IA 52101

Officer/Director/Trustee Four

BRIAN BACKES
BOARD SECRETARY
202 WEST MAIN STREET NUMBER 14
DECORAH IA 52101

Officer/Director/Trustee Five

ANNIE GALLAGHER
BOARD MEMBER
590 NORTH PO BOX 65
LANSING IA 52151

Organization’s website
Organization’s email NAMINEIOWA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/24/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 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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