FORM 1023-EZ for FOURTH ROOM THEATRE

Field Data
EIN 45-4753330
Case Number EO-2015125-000038
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FOURTH ROOM THEATRE
Organization’s Mailing Address 308 E BURLINGTON ST STE 138
City IOWA CITY
State IA
ZIP 52240
Accounting period End 6
Primary contact name KEVIN MOORE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

K MICHAEL MOORE
MANAGING DIRECTOR
308 E BURLINGTON ST STE138
IOWA CITY IA 52240

Officer/Director/Trustee Two

ANGIE TOOMSEN
MARKETING DIRECTOR
308 E BURLINGTON ST STE 138
IOWA CITY IA 52240

Officer/Director/Trustee Three

RACHEL KORACH-HOWELL
EDUCATION DIRECTOR
1322 WHITING AVE CT
IOWA CITY IA 52245

Officer/Director/Trustee Four

KEHRY ANSON-LANE
DIRECTOR
1322 WHITING AVE CT
IOWA CITY IA 52245

Officer/Director/Trustee Five

MATTHEW JAMES
DIRECTOR
1724 E STREET
IOWA CITY IA 52240

Organization’s website WWW.FOURTHROOMTHEATRE.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/18/2012
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A60 - Performing Arts Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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