FORM 1023-EZ for DAYBREAK INTERNATIONAL INC

Field Data
EIN 20-2357643
Case Number EO-2021221-000738
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DAYBREAK INTERNATIONAL INC
Organization’s Mailing Address 851 CAMBURN CT SE
City CEDAR RAPIDS
State IA
ZIP 52403
Accounting period End 12
Primary contact name BENJAMIN W VOTROUBEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BENJAMIN VOTROUBEK
DIRECTOR
1010 NORTH 14TH STREET
KEOKUK IA 52632

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/2005
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name BENJAMIN VOTROUBEK
Signature Title DIRECTOR
Signature Date 8/7/2021

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