FORM 1023-EZ for BROKEN WINGS

Field Data
EIN 82-2095636
Case Number EO-2019301-000712
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BROKEN WINGS
Organization’s Mailing Address 165 N MERAMEC AVE STE 110
City ST LOUIS
State MO
ZIP 63105
Accounting period End 12
Primary contact name LAUREN E SURDYKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SALLY RAPP
PRESIDENT
6232 ROSEBURY AVE STE 106
ST LOUIS MO 63105

Officer/Director/Trustee Two

TYLER WOTTERSTORFF
TREASURER
100 HERON COURT
ST LOUIS MO 63376

Officer/Director/Trustee Three

MARK BECKER
SECRETARY
6232 ROSEBURY AVE
ST LOUIS MO 63105

Officer/Director/Trustee Four

PATTY LUDWINSKI
DIRECTOR
501 ROLLING HILLS DRIVE
ST CHARLES MO 63304

Officer/Director/Trustee Five

EMILY GAYAN-ROTHLISBERGER
DIRECTOR
5966 WANDA
ST LOUIS MO 63116

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/24/19
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P62 - Victims' 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 SALLY RAPP
Signature Title PRESIDENT
Signature Date 10/25/19

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