FORM 1023-EZ for MYROOTS MISSION FOUNDATION INC

Field Data
EIN 83-1579709
Case Number EO-2018232-000290
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MYROOTS MISSION FOUNDATION INC
Organization’s Mailing Address 1510 WEST MAIN STREET
City SUN PRAIRIE
State WI
ZIP 53590
Accounting period End 12
Primary contact name MICHAEL J ALLEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

OUNPRASON INTHACHITH
PRESIDENT
1013 GLACIER HILL DRIVE
MADISON WI 53704

Officer/Director/Trustee Two

ELLEN ROSNER
DIRECTOR
905 MENOMONIE LANE
MADISON WI 53704

Officer/Director/Trustee Three

LIN COMPTON
DIRECTOR
3301 WESTVIEW LANE
MADISON WI 53713

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/18
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q12 - Fund Raising and/or Fund Distribution
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 Yes
Donation of funds No
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 OUNPRASON INTHACHITH
Signature Title PRESIDENT
Signature Date 8/16/18

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