FORM 1023-EZ for SEPHONIAS BREAKING BREAD COUNRTY BUFFET

Field Data
EIN 36-4752306
Case Number EO-2016014-000465
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SEPHONIAS BREAKING BREAD COUNRTY BUFFET
Organization’s Mailing Address 2904 100TH STREET
City FREDERIC
State WI
ZIP 54837
Accounting period End 12
Primary contact name SEPHONIA COWANS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SEPHONIA COWANS
DIRECTOR
2904 100TH STREET
FREDERIC WI 54837

Officer/Director/Trustee Two

RUSSELL COPELAND
MAINTENANCE DIRECTOR
6866 OLD A
WEBSTER WI 54893

Officer/Director/Trustee Three

BRUCE BLAIR
VICE PRESIDENT
14862 264TH STREET PATH
WELCH MN 55089

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/7/2013
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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
Signature Title
Signature Date

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