FORM 1023-EZ for BELLEVILLE AREA EMS MEMBERSHIP

Field Data
EIN 85-3208373
Case Number EO-2021049-000423
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BELLEVILLE AREA EMS MEMBERSHIP
Organization’s Mailing Address 480 RIVER ST PO BOX 20
City BELLEVILLE
State WI
ZIP 53508
Accounting period End 11
Primary contact name MEGAN SIPPY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MEGAN SIPPY
DIRECTOR
6800 243RD AVE
SALEM WI 53168

Officer/Director/Trustee Two

JAMIE STEPHENSON
DIRECTOR
N4020 GOLF LN
BRODHEAD WI 53520

Officer/Director/Trustee Three

DEBBIE BONGARD
DIRECTOR/PRESIDENT
232 N PARK ST
BELLEVILLE WI 53508

Officer/Director/Trustee Four

SARA NOVOTNY
SECRETARY/TREASURER
826 WELCH ST
BELLEVILLE WI 53508

Organization’s website WWW.BELLEVILLEEMS.ORG
Organization’s email CHIEF@BELLEVILLEEMS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2020
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E62 - Ambulance, Emergency Medical Transport Services
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 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MEGAN SIPPY
Signature Title DIRECTOR
Signature Date 12/10/2020

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