FORM 1023-EZ for INGRAM COMMUNITY CLUB

Field Data
EIN 86-3171197
Case Number EO-2021272-000249
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INGRAM COMMUNITY CLUB
Organization’s Mailing Address N4730 HIGHWAY 73
City INGRAM
State WI
ZIP 54526
Accounting period End 12
Primary contact name MARILYN ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARILYN ANDERSON
TREASURER
N5544 EDMING RD
GLEN FLORA WI 54526

Officer/Director/Trustee Two

JEREMIAH BILLER
PRESIDENT
N6100 STATE HWY 73
INGRAM WI 54526

Officer/Director/Trustee Three

DONALD STEVENS
VICE PRESIDENT
N7069 COUNTY RD B EAST
GLEN FLORA WI 54526

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/2021
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N31 - Community Recreational Centers
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
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 MARILYN ANDERSON
Signature Title TREASURER
Signature Date 9/27/2021

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