FORM 1023-EZ for MOTHERS MILK BANK OF THE WESTERN GREAT LAKES INC

Field Data
EIN 45-3994836
Case Number EO-2014237-000222
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOTHERS MILK BANK OF THE WESTERN GREAT LAKES INC
Organization’s Mailing Address 407 ORLEANS LANE
City SCHAUMBURG
State IL
ZIP 60193
Accounting period End 12
Primary contact name JED ROHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JENNIFER ANDERSON
EXECUTIVE DIRECTOR
407 ORLEANS LANE
SCHAUMBURG IL 60193

Officer/Director/Trustee Two

MAURA MCDONALD
TREASURER / DIRECTOR
2309 HOLLISTER AVE
MADISON WI 53726

Officer/Director/Trustee Three

MARISSA GROSSENBACH
BOARD CHAIR
14762 MAYLAND VILLA ROAD
LINCOLNSHIRE IL 60069

Officer/Director/Trustee Four

SUMMER KELLY
SECRETARY / DIRECTOR
4828 N NEENAH AVE
CHICAGO IL 60656

Officer/Director/Trustee Five

JED ROHER
DIRECTOR
ONE EAST MAIN STREET SUITE 500
MADISON WI 53703

Organization’s website MILKBANKWGL.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/22/2011
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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