FORM 1023-EZ for KIDS BACKPACK PROGRAM

Field Data
EIN 46-1429262
Case Number EO-2016088-000712
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KIDS BACKPACK PROGRAM
Organization’s Mailing Address 151 W MAPLE DR
City HARTLEY
State IA
ZIP 51346
Accounting period End 12
Primary contact name LAURA HOFTYZER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARSHA VANDER BROEK
DIRECTOR
151 W MAPLE DR
HARTLEY IA 51346

Officer/Director/Trustee Two

LAURA HOFTYZER
SECRETARY
231 N 7TH AVE W
HARTLEY IA 51346

Organization’s website
Organization’s email LAURAHOFTYZER@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/28/2016
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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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