FORM 1023-EZ for NEW BELGIUM COWORKER ASSISTANCE FUND INC

Field Data
EIN 47-1437244
Case Number EO-2015131-000237
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NEW BELGIUM COWORKER ASSISTANCE FUND INC
Organization’s Mailing Address 500 LINDEN STREET
City FORT COLLINS
State CO
ZIP 80524
Accounting period End 12
Primary contact name BRIAN WOLF
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MEGHAN OLESON
PRESIDENT/DIRECTOR
500 LINDEN STREET
FORT COLLINS CO 80524

Officer/Director/Trustee Two

KARI FLETCHER
VICE PRESIDENT/DIRECTOR
500 LINDEN STREET
FORT COLLINS CO 80524

Officer/Director/Trustee Three

MARCI PETERSON
TREASURER/DIRECTOR
500 LINDEN STREET
FORT COLLINS CO 80524

Officer/Director/Trustee Four

JOE DAVIS
SECRETARY/DIRECTOR
500 LINDEN STREET
FORT COLLINS CO 80524

Officer/Director/Trustee Five

MASON LATHROP
DIRECTOR
500 LINDEN STREET
FORT COLLINS CO 80524

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/28/2014
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P60 - Emergency Assistance (Food, Clothing, Cash)
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 Yes
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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