FORM 1023-EZ for AS ONE COMMUNITY

Field Data
EIN 35-2621865
Case Number EO-2018101-000513
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AS ONE COMMUNITY
Organization’s Mailing Address 498 ILLINOIS ROUTE 2 SUITE 109
City DIXON
State IL
ZIP 61021
Accounting period End 12
Primary contact name JOHN NOVAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOANNA GLENN
PRESIDENT
615 SECOND AVE
DIXON IL 61021

Officer/Director/Trustee Two

STEPHANIE KUZLIK
SECRETARY
705 NORTH ADAMS STREET
POLO IL 61064

Officer/Director/Trustee Three

JOHN NOVAK
TREASURER
1133 STEINMANN ST
DIXON IL 61021

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/19/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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 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 JOHN NOVAK
Signature Title TREASURER
Signature Date 4/9/18

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