FORM 1023-EZ for TEAM OF MERCY NEWTON IL BRANCH INC

Field Data
EIN 82-4091514
Case Number EO-2018176-000319
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TEAM OF MERCY NEWTON IL BRANCH INC
Organization’s Mailing Address 8622 N STATE HWY 130
City NEWTON
State IL
ZIP 62448
Accounting period End 12
Primary contact name TAMMY MICHL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BEVERELY DRAKE
PRESIDENT
2049 US ROUTE 40
GREENUP IL 62428

Officer/Director/Trustee Two

AUBREY BERGBOWER
VICE PRESIDENT
14737 E 1200TH AVE
NEWTON IL 62448

Officer/Director/Trustee Three

JANET VAHLING
SECRETARY
7781 EAST 1150TH AVE
NEWTON IL 62448

Officer/Director/Trustee Four

TAMMY MICHL
TREASURER
14296 N 1525TH ST
NEWTON IL 62448

Officer/Director/Trustee Five

TOM MATSON
TRUSTEE
402 E REYNOLDS ST
NEWTON IL 62448

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/5/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 TAMMY MICHL
Signature Title TREASURER
Signature Date 6/21/18

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