FORM 1023-EZ for JASON GROSSE MEMORIAL FOUNDATION LTD

Field Data
EIN 84-1907810
Case Number EO-2019176-000135
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JASON GROSSE MEMORIAL FOUNDATION LTD
Organization’s Mailing Address 3135 MEIER ROAD
City MADISON
State WI
ZIP 53718
Accounting period End 12
Primary contact name ALEXANDRA DAGGETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JULIE GROSSE
PRESIDENT & BOARD OF DIRECTOR
2524 RYELAND STREET
MADISON WI 53711

Officer/Director/Trustee Two

ADAM GROSSE
TREASURER & BOARD OF DIRECTOR
602 CHATHAM TERRACE
MADISON WI 53711

Officer/Director/Trustee Three

KAREN GROSSE
BOARD OF DIRECTOR
W1658 SANDSTONE AVENUE
RIPON WI 54971

Officer/Director/Trustee Four

RICHARD GROSSE
BOARD OF DIRECTOR
W1658 SANDSTONE AVENUE
RIPON WI 54971

Officer/Director/Trustee Five

ALEXANDRA DAGGETT
SECRETARY & BOARD OF DIRECTOR
943 CLARENCE COURT
MADISON WI 53715

Organization’s website N/A
Organization’s email JASONGROSSEMEMORIALFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/28/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T30 - Public Foundations
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 ALEXANDRA DAGGETT
Signature Title SECRETARY & BOARD OF DIRECTOR
Signature Date 6/20/19

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