FORM 1023-EZ for BURLINGTON FARMERS MARKET INC

Field Data
EIN 38-3785825
Case Number EO-2015114-000295
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BURLINGTON FARMERS MARKET INC
Organization’s Mailing Address 417 HERMAN ST
City BURLINGTON
State WI
ZIP 53105
Accounting period End 12
Primary contact name CAROL REED
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRIS SIMON
PRESIDENT
7624 CALDWEL ROAD
MUKWONAGO WI 53149

Officer/Director/Trustee Two

DIA KLEITSCH
VICE-PRESIDENT
COUNTY RD DD
BURLINGTON WI 53105

Officer/Director/Trustee Three

DAVID SPIEGELHOFF
DIRECTOR
690 WEST STATE ST
BURLINGTON WI 53105

Officer/Director/Trustee Four

JEAN SCHERRER
TREASURER/SECRETARY
449 KENDALL STREET
BURLINGTON WI 53105

Organization’s website WWW.BURLINGTONWIFARMERSMARKET.COM
Organization’s email BURLINGTONFRMARKET@SBCGLOBAL.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/23/2012
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K99 - Food, Agriculture, and Nutrition N.E.C.
Organization’s purpose Charitable: No
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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