FORM 1023-EZ for COLUMBUS IN ACTION INC

Field Data
EIN 82-5284514
Case Number EO-2018120-000443
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COLUMBUS IN ACTION INC
Organization’s Mailing Address 2204 14TH ST
City COLUMBUS
State NE
ZIP 68601
Accounting period End 12
Primary contact name SCOTT MUELLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SCOTT MUELLER
PRESIDENT
2204 14TH STREET
COLUMBUS NE 68601

Officer/Director/Trustee Two

CHRISTOPHER NELSON
VICE-PRESIDENT
2767 18TH AVENUE
COLUMBUS NE 68601

Officer/Director/Trustee Three

RICHARD JABLONSKI
SECRETARY-TREASURER
3260 42ND AVENUE
COLUMBUS NE 68601

Officer/Director/Trustee Four

RODNEY HASSEBROOK
DIRECTOR
27079 355TH STREET
COLUMBUS NE 68601

Officer/Director/Trustee Five

JORDAN MUELLER
DIRECTOR
21851 BAYSHORE DRIVE
COLUMBUS NE 68601

Organization’s website N/A
Organization’s email SCOTT@SAMSON-INC.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/18
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S99 - Community Improvement, Capacity Building N.E.C.
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 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 SCOTT MUELLER
Signature Title PRESIDENT
Signature Date 4/26/18

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