FORM 1023-EZ for LIVINGSTON COUNTY ULTRASOUND INITIATIVE

Field Data
EIN 47-2150041
Case Number EO-2014310-000511
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIVINGSTON COUNTY ULTRASOUND INITIATIVE
Organization’s Mailing Address 4074 CEMETERY ROAD
City FOWLERVILLE
State MI
ZIP 48836
Accounting period End 12
Primary contact name DALE RIETBERG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TIMOTHY DONOVAN
DIRECTOR / PRESIDENT
4074 CEMETERY
FOWLERVILLE MI 48836

Officer/Director/Trustee Two

LUCINDA DONOVAN
DIRECTOR / SECRETARY
4074 CEMETERY
FOWLERVILLE MI 48836

Officer/Director/Trustee Three

MARGARET WEINGARTZ
DIRECTOR
5360 OLD HICKORY DRIVE
BRIGHTON MI 48116

Officer/Director/Trustee Four

RODERICK FORMAN
TREASURER
2888 HIGH MEADOWS DRIVE
HOWELL MI 48843

Organization’s website WWW.LCULTRASOUND.ORG
Organization’s email TIM@LCULTRASOUND.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/23/2014
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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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