FORM 1023-EZ for MELLEN HOME AND SCHOOL ASSOCIATIONINC

Field Data
EIN 84-4173250
Case Number EO-2020009-000301
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MELLEN HOME AND SCHOOL ASSOCIATIONINC
Organization’s Mailing Address 67060
City MARENGO
State WI
ZIP 54855
Accounting period End 12
Primary contact name AMBER ERICKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMBER ERICKSON
PRESIDENT
67060 COUNTY HWY C
MARENGO WI 54855

Officer/Director/Trustee Two

CALLA ERICKSON
SEC/TREAS
38300 STATE HWY 13
HIGHBRIDGE WI 54846

Officer/Director/Trustee Three

HOLLY DENNY
VICE PRESIDENT
36530 GOLF COURSE RD
MELLEN WI 54546

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/19/2019
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B94 - Parent/Teacher Group
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 AMBER ERICKSON
Signature Title PRESIDENT
Signature Date 1/7/2020

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