FORM 1023-EZ for MERCY WATERS

Field Data
EIN 46-0934256
Case Number EO-2016252-000178
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MERCY WATERS
Organization’s Mailing Address 29515 80TH AVE N
City HILLSDALE
State IL
ZIP 61257-9621
Accounting period End 12
Primary contact name MICHAEL GRAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL GRAY
PRESIDENT
29515 80TH AVE N
HILLSDALE IL 61257-9621

Officer/Director/Trustee Two

JULIE GRAY
SECRETARY
2951580TH AVE N
HILLSDALE IL 61257-9621

Officer/Director/Trustee Three

JOHN KESSLER
TREASURER
3226 45TH ST
MOLINE IL 61265

Officer/Director/Trustee Four

ERIN KRISTOFFERSON
DIRECTOR
29515 80TH AVE N
HILLSDALE IL 61257-9621

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/27/2013
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P12 - 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 Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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