FORM 1023-EZ for TIPTON YOUTH BASKETBALL ASSOCIATION

Field Data
EIN 46-3901849
Case Number EO-2014321-000340
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TIPTON YOUTH BASKETBALL ASSOCIATION
Organization’s Mailing Address 1201 NORTH AVENUE
City TIPTON
State IA
ZIP 52772-1143
Accounting period End 6
Primary contact name MARK PENNINGROTH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KRISTIN HERMSEN
PRESIDENT
1302 PLUM STREET
TIPTON IA 52772-1355

Officer/Director/Trustee Two

SAMANTHA REZAC
VICE PRESIDENT, DIRECTOR
1522 MULBERRY STREET
TIPTON IA 52772-1308

Officer/Director/Trustee Three

JULIE FORD
TREASURER
1502 LOGAN AVENUE
TIPTON IA 52772-9596

Officer/Director/Trustee Four

DAWN ANDERSON
SECRETARY, DIRECTOR
1507 180TH STREET
CLARENCE IA 52216-9352

Officer/Director/Trustee Five

LISA MOSIER
DIRECTOR
110 MEADOW LANE
TIPTON IA 52772-1304

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/4/2013
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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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