FORM 1023-EZ for BLUE HERON INIPI

Field Data
EIN 82-4237780
Case Number EO-2018033-000309
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLUE HERON INIPI
Organization’s Mailing Address 5114 LOCUST STREET
City LINCOLN
State NE
ZIP 68516-1247
Accounting period End 12
Primary contact name BILL ACHORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANTONIO LARAVIE
PRESIDENT
5114 LOCUST STREET
LINCOLN NE 68516-1247

Officer/Director/Trustee Two

HOLLY TAYLOR
VICE PRESIDENT
1408 SAINT RAPHAEL STREET
BELLEVUE NE 68005-4940

Officer/Director/Trustee Three

BILL ACHORD
SECRETARY-TREASURER
5114 LOCUST STREET
LINCOLN NE 68516-1247

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/15/18
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 BILL ACHORD
Signature Title SECRETARY-TREASURER
Signature Date 1/31/18

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