FORM 1023-EZ for NICKELS INTERMEDIATE FAMILY INVOLVEMENT TEAM

Field Data
EIN 20-1696800
Case Number EO-2017237-000206
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NICKELS INTERMEDIATE FAMILY INVOLVEMENT TEAM
Organization’s Mailing Address 8638 BYRON CENTER AVE SW
City BYRON CENTER
State MI
ZIP 49315
Accounting period End 6
Primary contact name AMANDA MEDALEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMANDA MEDALEN
DIRECTOR
2029 CONIFER RIDGE DR
BYRON CENTER MI 49315

Officer/Director/Trustee Two

DEVON STUBBLEFIELD
DIRECTOR
2004 PAVILION DR
BYRON CENTER MI 49315

Officer/Director/Trustee Three

TIFFANY POJESKI
DIRECTOR
1885 PLANTERS ROW DR
BYRON CENTER MI 49315

Officer/Director/Trustee Four

KRISTIN RHOTON
DIRECTOR
2041 CANOPY DR
BYRON CENTER MI 49315

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/7/2005
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B94 - Parent/Teacher Group
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 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
Signature Title
Signature Date

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