FORM 1023-EZ for ELLSWORTH COMMUNITY ASSOCIATION

Field Data
EIN 42-1281038
Case Number EO-2019235-000303
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ELLSWORTH COMMUNITY ASSOCIATION
Organization’s Mailing Address PO BOX 272
City ELLSWORTH
State IA
ZIP 50075-272
Accounting period End 12
Primary contact name JON ROLLEFSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARCY OLSON
PRESIDENT
PO BOX 93
ELLSWORTH IA 50075

Officer/Director/Trustee Two

PAM HOCKING
VICE PRESIDENT
3260 320TH ST
ELLSWORTH IA 50075

Officer/Director/Trustee Three

JON ROLLEFSON
TREASURER
1823 DELPHI ST
ELLSWORTH IA 50075

Organization’s website WWW.ELLSWORTHIOWA.ORG
Organization’s email ELLSWORTHCA@NETINS.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/54
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name JON ROLLEFSON
Signature Title TREASURER
Signature Date 8/21/19
EIN 42-1281038
Case Number EO-2015327-000467
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ELLSWORTH COMMUNITY ASSOCIATION
Organization’s Mailing Address PO BOX 272
City ELLSWORTH
State IA
ZIP 50075
Accounting period End 12
Primary contact name JESSICA NELSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHANE NELSON
PRESIDENT
545 DECORA AVE
ELLSWORTH IA 50075

Officer/Director/Trustee Two

JESSICA NELSON
TREASURER
545 DECORA AVE
ELLSWORTH IA 50075

Officer/Director/Trustee Three

SHELLY ZIMMERMAN
SECRETARY
1816 DECOTA ST
ELLSWORTH IA 50075

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/1954
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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