FORM 1023-EZ for AMBOSS INCORPORATED

Field Data
EIN 84-2638350
Case Number EO-2019360-000274
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AMBOSS INCORPORATED
Organization’s Mailing Address 11308 BLUE SPARROW COURT
City FT WAYNE
State IN
ZIP 46845
Accounting period End 12
Primary contact name JERRY WINEGARDEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JERRY WINEGARDEN
CHAIRMAN
11308 BLUE SPARROW COURT
FT WAYNE IN 46845

Officer/Director/Trustee Two

KIRKPARTICK WINEGARDEN
DIRECTOR
1122 LARCH LANE
FT WAYNE IN 46825

Officer/Director/Trustee Three

LUKAS WINEGARDEN
DIRECTOR
2225 GLENWOOD AVENUE
FT WAYNE IN 46805

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/6/2019
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X19 - Nonmonetary Support N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Conducting Activities Outside of United States Yes
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 JERRY WINEGARDEN
Signature Title CHAIRMAN
Signature Date 12/23/2019

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