FORM 1023-EZ for RURAL LIFE CENTER AT MEADOW BROOK FARM - COUILLARDVILLE INC

Field Data
EIN 85-0805225
Case Number EO-2020212-000066
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RURAL LIFE CENTER AT MEADOW BROOK FARM - COUILLARDVILLE INC
Organization’s Mailing Address PO BOX 151
City OCONTO
State WI
ZIP 54153
Accounting period End 12
Primary contact name THOMAS W MONIZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LARA NICHOLS
PRESIDENT
213 QUINCY STREET
OCONTO WI 54153

Officer/Director/Trustee Two

MIKE DONLEVY
VICE PRESIDENT
5678 COUNTY ROAD J
OCONTO WI 54153

Officer/Director/Trustee Three

GREG SENN
SECRETARY
610 PARK STREET
WAUPUN WI 53963

Officer/Director/Trustee Four

JOHN MATRAVERS
TREASURER
1415 PARK STREET
OCONTO WI 54153

Officer/Director/Trustee Five

BILL FUNK
DIRECTOR
5682 FUNK ROAD
LENA WI 54139

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/2020
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C34 - Land Resources Conservation
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 LARA NICHOLS
Signature Title PRESIDENT
Signature Date 7/28/2020

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