FORM 1023-EZ for CLAYTON COUNTY EMS ASSOCIATION INC

Field Data
EIN 61-1698050
Case Number EO-2018060-000214
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLAYTON COUNTY EMS ASSOCIATION INC
Organization’s Mailing Address 111 COMMERCIAL ST
City STRAWBERRY POINT
State IA
ZIP 52076-279
Accounting period End 12
Primary contact name THERESA CALLAHAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THERESA CALLAHAN
PRESIDENT
PO BOX 73
STRAWBERRY POINT IA 52076-73

Officer/Director/Trustee Two

RUSTY EILERS
VICE-PRESIDENT
422 S BLUFF ST
GUTTENBERG IA 52052

Officer/Director/Trustee Three

TERESA SHEA
SECRETARY
200 NORTH ST
VOLGA IA 52077

Officer/Director/Trustee Four

KEN HOEGER
TREASURER
115 KRISTINE AVE
ELKADER IA 52043

Organization’s website
Organization’s email CLAYTONCOUNTYEMS@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/23/04
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M23 - Search and Rescue Squads, Services
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 THERESA CALLAHAN
Signature Title PRESIDENT
Signature Date 2/27/18

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