FORM 1023-EZ for ANGEL FOR SAM

Field Data
EIN 47-3366423
Case Number EO-2015076-000199
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ANGEL FOR SAM
Organization’s Mailing Address 3700 SE 25TH CT
City DES MOINES
State IA
ZIP 50320
Accounting period End 12
Primary contact name CHAD EICHORN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DENISE SULLIVAN
PRESIDENT/DIRECTOR
4770 NE 38TH AVE
DES MOINES IA 50317

Officer/Director/Trustee Two

JENNY SSULLIVAN
VICE PRESIDENT/DIRECTOR
3701 BROOK RIDGE CT 1004
DES MOINES IA 50317

Officer/Director/Trustee Three

CATHY ZUST
DIRECTOR
3100 EAST 42ND CT
DES MOINES IA 50317

Officer/Director/Trustee Four

LINDA FRAZIER
TREASURER/DIRECTOR
3700 SE 25TH CT
DES MIONES IA 50320

Officer/Director/Trustee Five

JOAN OSBORN
SECRETARY/DIRECTOR
2300 E 23RD
DES MOINES IA 50317

Organization’s website NONE
Organization’s email CEICHORN@DSMLAWYERS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G12 - Fund Raising and/or Fund Distribution
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 Yes
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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