FORM 1023-EZ for BLOOMVILLE FOOD PANTRY

Field Data
EIN 81-4148013
Case Number EO-2016299-000131
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLOOMVILLE FOOD PANTRY
Organization’s Mailing Address 26 E NEW HAVEN STREET
City BLOOMVILLE
State OH
ZIP 44818
Accounting period End 12
Primary contact name JOSEPH G JACKSON- PRESIDENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSEPH JACKSON
PRESIDENT
20 NORTH STREET
BLOOMVILLE OH 44818

Officer/Director/Trustee Two

JANET SCHUELER
TREASURER
10687 EAST TOWNSHIP ROAD 44
BLOOMVILLE OH 44818

Officer/Director/Trustee Three

CHRISTINA JACKSON
SECRETARY
20 NORTH STREET
BLOOMVLLE OH 44818

Officer/Director/Trustee Four

HEATHER HOOD
VICE PRESIDENT
8614 EAST COUNTY ROAD 12
BLOOMVILLE OH 44818

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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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