FORM 1023-EZ for FIRST 5 FOX VALLEY INC

Field Data
EIN 85-3772281
Case Number EO-2021028-000006
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FIRST 5 FOX VALLEY INC
Organization’s Mailing Address 1001 W KENNEDY AVENUE SUITE A
City KIMBERLY
State WI
ZIP 54136
Accounting period End 12
Primary contact name BARBARA TENGESDAL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WENDY HEIN
PRESDIENT
313 S STATE STREET
APPLETON WI 54911

Officer/Director/Trustee Two

ALLISON LAVERTY-MONTAG
VICE-PRESIDENT
112 OTTER AVENUE PO BOX 2808
OSHKOSH WI 54903

Officer/Director/Trustee Three

OLIVER ZORNOW
SECRETARY
100 W COLLEGE AVENUE
APPLETON WI 54911

Officer/Director/Trustee Four

JUDY OLSON
TREASURER
1001 W KENNEDY AVENUE SUITE A
KIMBLERY WI 54136

Organization’s website www.ccrrfoxvalley.org/first-five-fox-valley.com
Organization’s email Director@firstfivefoxvalley.org
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/26/2020
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 No
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 WENDY HEIN
Signature Title PRESDIENT
Signature Date 12/3/2020

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