FORM 1023-EZ for KELLER GORMAN FAMILY FOUNDATION

Field Data
EIN 84-3041043
Case Number EO-2019284-000276
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KELLER GORMAN FAMILY FOUNDATION
Organization’s Mailing Address 2801 SOUTHFIELD DR
City QUINCY
State IL
ZIP 62301
Accounting period End 12
Primary contact name DENNIS W GORMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENNIS GORMAN
DIRECTOR & PRESIDENT
2801 SOUTHFIELD DR
QUINCY IL 62301

Officer/Director/Trustee Two

BARBARA GORMAN
DIRECTOR & VICE PRESIDENT
2801 SOUTHFIELD DR
QUINCY IL 62301

Officer/Director/Trustee Three

DEBORAH GORMAN
DIRECTOR & TREASURER
1845 JERSEY ST
QUINCY IL 62301

Officer/Director/Trustee Four

WENDY KOONTZ
DIRECTOR & SECRETARY
3316 CAMBRIDGE ESTATES
QUINCY IL 62301

Officer/Director/Trustee Five

TIMOTHY KOONTZ
DIRECTOR & VICE PRESIDENT
3316 CAMBRIDGE ESTATES
QUICNY IL 62301

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/4/19
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DENNIS GORMAN
Signature Title DIRECTOR & PRESIDENT
Signature Date 10/8/19

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