FORM 1023-EZ for THE SHUBO FOUNDATION

Field Data
EIN 84-4172255
Case Number EO-2020013-000527
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE SHUBO FOUNDATION
Organization’s Mailing Address 1103 POLK BLVD
City DES MOINES
State IA
ZIP 50311
Accounting period End 12
Primary contact name PATRICK GRAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NICK BOVA
PRESIDENT
15935 PAINT AVE
GREENWELL SPRINGS LA 70739

Officer/Director/Trustee Two

CHAD MILINE
VICE-PRESIDENT
1972 BARBER DR APT 1
STOUGHTON WI 53589

Officer/Director/Trustee Three

PATRICK GRAY
SECRETARY
1103 POLK BLVD
DES MOINES IA 50311

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/6/2020
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P01 - Alliance/Advocacy Organizations
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 Yes
Donation of funds No
Conducting Activities Outside of United States Yes
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 PATRICK GRAY
Signature Title SECRETARY
Signature Date 1/11/2020

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