FORM 1023-EZ for ASD FOUNDATION INC

Field Data
EIN 47-4975016
Case Number EO-2015251-000348
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ASD FOUNDATION INC
Organization’s Mailing Address 920 S WAUKEGAN ROAD SUITE 300
City LAKE FOREST
State IL
ZIP 60045
Accounting period End 12
Primary contact name JERROLD P JACKS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JERROLD JACKS
PRESIDENT
920 S WAUKEGAN ROAD SUITE 300
LAKE FOREST IL 60045

Officer/Director/Trustee Two

BERNICE BARANEK
VP
6230 10TH STREET
KENOSHA WI 53144

Officer/Director/Trustee Three

PETER BARANEK
SEC/TRES
6230 10TH STREET
KENOSHA WI 53144

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/3/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, Services
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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