FORM 1023-EZ for NAMI SOUTHWEST IOWA

Field Data
EIN 82-3642615
Case Number EO-2018043-000494
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NAMI SOUTHWEST IOWA
Organization’s Mailing Address BOX 31
City CLARINDA
State IA
ZIP 51632
Accounting period End 12
Primary contact name BERNEETA WAGONER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BERNEETA WAGONER
PRESIDENT
215 EAST WASHINGTON
CLARINDA IA 51632

Officer/Director/Trustee Two

AMANDA OWENS
SECRETARY
309 FRANKLIN
COLLEGE SPRINGS IA 51637

Officer/Director/Trustee Three

KAREN WILLIAMS
MEMBER
BOX 282
CLARINDA IA 51632

Officer/Director/Trustee Four

KELLI PEDERSON
MEMBER
216 WEST DIVISION
CLARINDA IA 51632

Officer/Director/Trustee Five

KENDRA WILSON
MEMBER
933 EAST PIERCE
COUNCIL BLUFFS IA 51503

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/18
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 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name BERNEETA WAGONER
Signature Title PRESIDENT
Signature Date 2/10/18

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