| Field | Data |
|---|---|
| EIN | 81-3035310 |
| Case Number | EO-2016256-000235 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | FORT WAYNE BRAIN INJURY CLUBHOUSE |
| Organization’s Mailing Address | 7209 ENGLE ROAD |
| City | FORT WAYNE |
| State | IN |
| ZIP | 46804 |
| Accounting period End | 6 |
| Primary contact name | DAVE DICKMEYER |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
DAVE DICKMEYER
PRESIDENT
7209 ENGLE ROAD
FORT WAYNE IN 46804
ALAN NEUENSCHWANDER
VICE PRESIDENT
7209 ENGLE ROAD
FORT WAYNE IN 46804
GREGORY MANNIA
TREASURER
7209 ENGLE ROAD
FORT WAYNE IN 46804
NANCY STANSBERRY
SECRETARY
7209 ENGLE ROAD
FORT WAYNE IN 46804
JULIE KINTZ
DIRECTOR
7209 ENGLE ROAD
FORT WAYNE IN 46804
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 6/22/2016 |
| Organization Incorporation State | IN |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | F30 - Mental Health Treatment - Multipurpose and N.E.C. |
| 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 | |
| Signature Title | |
| Signature Date |
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