FORM 1023-EZ for NAMI SOUTHEAST IOWA

Field Data
EIN 37-1905510
Case Number EO-2019029-000567
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NAMI SOUTHEAST IOWA
Organization’s Mailing Address PO BOX 174
City W BURLINGTON
State IA
ZIP 52566-121
Accounting period End 6
Primary contact name TERRI ELLIOTT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TAMEE DECOURSEY
VOLUNTEER
110 ROOSEVELT
DANVILLE IA 52623-9410

Officer/Director/Trustee Two

JONI M ELDER
TRUSTEE
301 W BURLINGTON AVE
FAIRFIELD IA 52556-3909

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/26/18
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - 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 Yes
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 JONI M ELDER
Signature Title TRUSTEE
Signature Date 12/18/18

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