FORM 1023-EZ for EXAMPLE ACADEMY INC

Field Data
EIN 85-4288117
Case Number EO-2021043-000011
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EXAMPLE ACADEMY INC
Organization’s Mailing Address 1503 WINGO LANE UNIT 4
City BOURBONNAIS
State IL
ZIP 60914
Accounting period End 12
Primary contact name DOREEN STREETER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BARRY BRADFORD
PRESIDENT
1503 WINGO LANE UNIT 4
BOURBONNAIS IL 60914

Officer/Director/Trustee Two

JOHNNIE WICKS
SECRETARY
1577 MID COURT DRIVE
BOURBONNAIS IL 60914

Officer/Director/Trustee Three

AISHA CHAVERS-BRADFORD
TREASURER
1503 WINGO LANE UNIT 4
BOURBONNAIS IL 60914

Officer/Director/Trustee Four

KIMBERLY FUDGE
DIRECTOR
347 E CENTER STREET
GLENWOOD IL 60425

Officer/Director/Trustee Five

LISA POREMBA-BERG
DIRECTOR
450 S ROOSEVELT AVE
KANKAKEE IL 60901

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/2020
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other 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 No
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 BARRY BRADFORD
Signature Title PRESIDENT
Signature Date 12/24/2020

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