FORM 1023-EZ for ANTHONY WAYNE COMMUNITY FOOD MINISTRY

Field Data
EIN 47-1422881
Case Number EO-2014251-000597
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ANTHONY WAYNE COMMUNITY FOOD MINISTRY
Organization’s Mailing Address 11129 OBEE ROAD
City WHITEHOUSE
State OH
ZIP 43571
Accounting period End 12
Primary contact name RONALD SHOEMAKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KAREN VANDERPLOEG
PRESIDENT
18 S SIXTH STREET
WATERVILLE OH 43566

Officer/Director/Trustee Two

DAVE BRUNS
VICE PRESIDENT
109 N RIVER ROAD
WATERVILLE OH 43566

Officer/Director/Trustee Three

LINDA BLOMQUIST
TREASURER
6245 BERKEY SOUTHERN ROAD
WHITEHOUSE OH 43571

Officer/Director/Trustee Four

ROSA SHOEMAKER
SECRETERAY
6050 WATERVILLE-MONCLOVA ROAD
WATERVILLE OH 43566

Officer/Director/Trustee Five

BRYAN LAUER
DIRECTOR
11123 WEST STREET
WHITEHOUSE OH 43571

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/23/2014
Organization Incorporation State OH
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 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 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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