FORM 1023-EZ for CLEAN AMERICA COMPANY INC

Field Data
EIN 84-1889868
Case Number EO-2019151-000269
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLEAN AMERICA COMPANY INC
Organization’s Mailing Address E13758 STATE ROAD 82
City LA FARGE
State WI
ZIP 54639
Accounting period End 5
Primary contact name MICHAEL DONSKEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL DONSKEY
DIRECTOR
E13758 STATE ROAD 82
LA FARGE WI 54639

Officer/Director/Trustee Two

MARCY DONSKEY
DIRECTOR
E13758 STATE ROAD 82
LA FARGE WI 54639

Officer/Director/Trustee Three

MICHAEL DONSKEY II
DIRECTOR
E13758 STATE ROAD 82
LA FARGE WI 54639

Officer/Director/Trustee Four

GRACY DONSKEY
DIRECTOR
E13758 STATE ROAD 82
LA FARGE WI 54639

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code U99 - Science and Technology Research Institutes, Services N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: Yes
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 MICHAEL DONSKEY
Signature Title DIRECTOR
Signature Date 5/29/19

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