FORM 1023-EZ for CAMP RYAN ADAMS INC

Field Data
EIN 47-2328833
Case Number EO-2014336-000372
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAMP RYAN ADAMS INC
Organization’s Mailing Address W10255 STATE ROAD 60
City LODI
State WI
ZIP 53555
Accounting period End 12
Primary contact name PAUL A JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GARY NOWOBIELSKI
DIRECTOR
W10255 STATE ROAD 60
LODI WI 53555-9411

Officer/Director/Trustee Two

ROY LILLO
DIRECTOR
307 WESTOVER ROAD
EAU CLAIRE WI 54701-7175

Officer/Director/Trustee Three

MATT TENNESSON
DIRECTOR
156 DARBOY ROAD
KIMBERLY WI 54136-1627

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/12/2014
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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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