FORM 1023-EZ for ADAM BREITRICK MEMORIAL CORP

Field Data
EIN 82-4641219
Case Number EO-2019154-000154
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADAM BREITRICK MEMORIAL CORP
Organization’s Mailing Address N5122 SUMMIT DR
City FOND DU LAC
State WI
ZIP 54937-9688
Accounting period End 12
Primary contact name DEBORAH BREITRICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBORAH BREITRICK
DIRECTOR
N5122 SUMMIT DR
FOND DU LAC WI 54937

Officer/Director/Trustee Two

DEBRA WINTERHACK
DIRECTOR
N5122 SUMMIT DR
FOND DU LAC WI 54937

Officer/Director/Trustee Three

LORI TAYLOR
DIRECTOR
N5122 SUMMIT DR
FOND DU LAC WI 54937

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/29/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 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 DEBORAH BREITRICK
Signature Title DIRECTOR
Signature Date 5/30/19

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