FORM 1023-EZ for FAMILY CAREGIVERS ROCK

Field Data
EIN 83-3406405
Case Number EO-2019050-000128
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY CAREGIVERS ROCK
Organization’s Mailing Address PO BOX 2434
City APPLETON
State WI
ZIP 54912-2434
Accounting period End 12
Primary contact name CYNTHIA THOMPSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CYNTHIA THOMPSON
CHAIR/SECRETARY
824 S WESTHAVEN PL UNIT G
APPLETON WI 54914-4473

Officer/Director/Trustee Two

TANDY ELISALA
VICE CHAIR
9010 S PRIEST DR APT 2151
TEMPE AR 85284-3540

Officer/Director/Trustee Three

VIRGINIA DRIVER
TREASURER
231 COUNTRYSIDE CT UNIT D
WAUPACA WI 54981-8701

Officer/Director/Trustee Four

JAMES HOLMES
MEMBER
832 N 6TH ST UNIT 407
SHEBOYGAN WI 53081-5065

Organization’s website WWW.FAMILYCAREGIVERSROCK.ORG
Organization’s email FAMILYCAREGIVERSROCK@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P58 - Gift 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 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 CYNTHIA THOMPSON
Signature Title CHAIR
Signature Date 2/14/19

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