FORM 1023-EZ for FOX VALLEY CHAOS RUGBY

Field Data
EIN 86-2545562
Case Number EO-2021099-000467
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOX VALLEY CHAOS RUGBY
Organization’s Mailing Address 404 FRANCES ST
City KAUKAUNA
State WI
ZIP 54130
Accounting period End 5
Primary contact name CAYLEE RZENTKOWSKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CAYLEE RZENTKOWSKI
TREASURER
404 FRANCES ST
KAUKAUNA WI 54130

Officer/Director/Trustee Two

ANDI HEESAKER
PRESIDENT
1650 UNIVERSITY DR APT 2
MENASHA WI 54952

Officer/Director/Trustee Three

ABBY JANKOWSKI
VICE PRESIDENT
1002 W ELSIE ST
APPLETON WI 54914

Officer/Director/Trustee Four

SARAH ROWLEY
SECRETARY
327 N WESTHAVEN DR APTQ208
OSHKOSH WI 54904

Officer/Director/Trustee Five

NICOLE TIMM
RECRUITER
1624 W EVERGREEN DR APT 5
APPLETON WI 54913

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/9/2019
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 CAYLEE RZENTKOWSKI
Signature Title TREASURER
Signature Date 3/22/2021

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