FORM 1023-EZ for EMS ROADDOCS INC

Field Data
EIN 46-1454927
Case Number EO-2015063-000204
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMS ROADDOCS INC
Organization’s Mailing Address 2514 BURBANK AVE
City JANESVILLE
State WI
ZIP 53546
Accounting period End 12
Primary contact name WILLIAM BENSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM BENSON
PRESIDENT, DIRECTOR
2514 BURBANK AVE
JANESVILLE WI 53546

Officer/Director/Trustee Two

JOSHUA CHOATE
SECRETARY, DIRECTOR
2514 BURBANK AVE
JANESVILLE WI 53546

Officer/Director/Trustee Three

PETER SZCZEPANIK
TREASURER, DIRECTOR
2514 BURBANK AVE
JANESVILLE WI 53546

Organization’s website WWW.EMSROADDOCS.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2012
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 No
One Third Support Public No
One Third Support Gifts Yes
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
EIN 46-1454927
Case Number EO-2015323-000213
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMS ROADDOCS INC
Organization’s Mailing Address 2514 BURBANK AVE
City JANESVILLE
State WI
ZIP 53546
Accounting period End 12
Primary contact name WILLIAM BENSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM BENSON
PRESIDENT, DIRECTOR
2514 BURBANK AVE
JANESVILLE WI 53546

Officer/Director/Trustee Two

JOSHUA CHOATE
SECRETARY, DIRECTOR
2514 BURBANK AVE
JANESVILLE WI 53546

Officer/Director/Trustee Three

PETER SZCZEPANIK
TREASURER, DIRECTOR
2514 BURBANK AVE
JANESVILLE WI 53546

Officer/Director/Trustee Four

CLIFFORD DEBRUCE
DIRECTOR
17 KNOTTY PNES
TEXARKANA TX 75503

Organization’s website WWW.EMSROADDOCS.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2012
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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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