FORM 1023-EZ for SIOUXLAND ADAPTIVE SPORTS INC

Field Data
EIN 83-1884952
Case Number EO-2019198-000117
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SIOUXLAND ADAPTIVE SPORTS INC
Organization’s Mailing Address 163 9TH ST CIRCLE SE
City SIOUX CENTER
State IA
ZIP 51250
Accounting period End 12
Primary contact name BRADY A KROEZE CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHERYL HORSTMAN
PRESIDENT
163 9TH ST CIRCLE SE
SIOUX CENTER IA 51250

Officer/Director/Trustee Two

MARK HORSTMAN
TREASURER
163 9TH ST CIRCLE SE
SIOUX CENTER IA 51250

Officer/Director/Trustee Three

JONI ROORDA
SECRETARY
512 4TH ST
MAURICE IA 51036

Officer/Director/Trustee Four

JULIE DUDEN
VICE PRESIDENT
905 4TH AVE NE
SIOUX CENTER IA 51250

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/12/19
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 CHERYL HORSTMAN
Signature Title PRESIDENT
Signature Date 7/15/19

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