FORM 1023-EZ for NICABEJA PROYECTO INC

Field Data
EIN 81-0843546
Case Number EO-2019121-000079
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NICABEJA PROYECTO INC
Organization’s Mailing Address PO BOX 501
City PORTAGE
State WI
ZIP 53901
Accounting period End 12
Primary contact name MARTIN HAVLOVIC
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARTIN HAVLOVIC
PRESIDENT & DIRECTOR
2835 NORTHRIDGE DRIVE
PORTAGE WI 53901

Officer/Director/Trustee Two

KENT PEGORSCH
VICE PRESIDENT & DIRECTOR
103 N MAIN STREET
PORTAGE WI 53901

Officer/Director/Trustee Three

MICHAEL BAUER
SECRETARY-TREASURER & DIRECTOR
E1810 LARSEN ROAD
WAUPACA WI 54981

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/16/15
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K99 - Food, Agriculture, and Nutrition 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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARTIN HAVLOVIC
Signature Title PRESIDENT & DIRECTOR
Signature Date 4/29/19
EIN 81-0843546
Case Number EO-2016060-000119
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NICABEJA PROYECTO INC
Organization’s Mailing Address 2835 NORTHRIDGE DRIVE NO 4
City PORTAGE
State WI
ZIP 53901
Accounting period End 12
Primary contact name GEORGE SCHROEDER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL BAUER
DIRECTOR
E1810 LARSEN RD
WAUPACA WI 54981

Officer/Director/Trustee Two

MARTIN HAVLOVIC
DIRECTOR
2835 NORTHRIDGE DR NO 4
PORTAGE WI 53901

Officer/Director/Trustee Three

KENT PEGORSCH
DIRECTOR
103 N MAIN ST
WAUPACA WI 54981

Officer/Director/Trustee Four

GEORGE SCHROEDER
DIRECTOR
4705 BUTTERCUP COURT
APPLETON WI 54914

Officer/Director/Trustee Five

DINO TLACHAC
DIRECTOR
5223 WHY 66
STEVENS POINT WI 54481

Organization’s website
Organization’s email GEORGE.M.SCHROEDER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/16/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 Yes
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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