FORM 1023-EZ for WORTHINGTON FIRE PROTECTION ASSOCIATION

Field Data
EIN 81-3932799
Case Number EO-2016272-000288
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WORTHINGTON FIRE PROTECTION ASSOCIATION
Organization’s Mailing Address 229 1ST AVE E
City DYERSVILLE
State IA
ZIP 52040
Accounting period End 12
Primary contact name JUDE MILBERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFF THIER
PRESIDENT
29562 E WORTHINGTON RD
WORTHINGTON IA 52078

Officer/Director/Trustee Two

RANDY COOK
SEC./TREAS.
32733 ROCKVILLE RD
WORTHINGTON IA 52078

Officer/Director/Trustee Three

CHUCK ROLING
DIRECTOR
5445 ROLING RD
WORTHINGTON IA 52078

Officer/Director/Trustee Four

MARK KNIPPER
DIRECTOR
2998 160TH ST
HOPKINTON IA 52237

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/9/2016
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M24 - Fire Prevention, Protection, Control
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
Signature Title
Signature Date

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