FORM 1023-EZ for STRIKEOUT TYPE 1 DIABETES

Field Data
EIN 47-5592232
Case Number EO-2016354-000173
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STRIKEOUT TYPE 1 DIABETES
Organization’s Mailing Address 17 N ADAMS
City BROWNSBURG
State IN
ZIP 46112-8834
Accounting period End 12
Primary contact name AMY SAMPEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMY SAMPEN
PRESIDENT
11 CARNABY COURT
BROWNSBURG IN 46112-8834

Officer/Director/Trustee Two

WILLIAM SAMPEN
SECRETARY
11 CARNABY CT
BROWNSBURG IN

Officer/Director/Trustee Three

JOHN PAUL BIEHN
TREASURER
757 N GREEN
BROWNSBURG IN 46112-8834

Officer/Director/Trustee Four

DIANE GREEN
DIRECTOR
15 CARNABY CT
BROWNSBURG IN 46112

Officer/Director/Trustee Five

SOPHIA PORTUONDO
DIRECTOR
11 CARNABY COURT
BROWNSBURG IN 46112-8834

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/9/2015
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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