FORM 1023-EZ for LBGT SERVICES OF WINNEBAGO COUNTY INC

Field Data
EIN 82-3509691
Case Number EO-2018110-000214
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LBGT SERVICES OF WINNEBAGO COUNTY INC
Organization’s Mailing Address 1116 CANNELL CT SUITE 10
City ROCKTON
State IL
ZIP 61072
Accounting period End 12
Primary contact name RONALD NELSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RONALD NELSON
PRESIDENT SECRETARY
1207 WATTS AVE
ROCKTON IL 61072

Officer/Director/Trustee Two

BRANDON DEVER
BOARD MEMBER
419 BLEECHER ST
ROCKTON IL 61072

Officer/Director/Trustee Three

JOHN JOHANSEN
VICE PRESIDENT
419 BLEERCHER ST
ROCKTON IL 61072

Officer/Director/Trustee Four

KATHRYN GUSTAFSON
BOARD MEMBER
726 E WARREN ST
ROCKTON IL 61072

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/26/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R20 - Civil Rights, Advocacy for Specific Groups
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 Yes
Donation of funds Yes
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 RONALD NELSON
Signature Title PRESIDENT SECRETARY
Signature Date 4/18/18

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