FORM 1023-EZ for COUNTED WORTHY INC

Field Data
EIN 47-5655986
Case Number EO-2016215-000087
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COUNTED WORTHY INC
Organization’s Mailing Address 4947 EAGLE LANE
City WEST BEND
State WI
ZIP 53095
Accounting period End 12
Primary contact name JAMES CRAIG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES CRAIG
DIRECTOR
4847 EAGLE LANE
WEST BEND WI 53095

Officer/Director/Trustee Two

JULIE CRAIG
DIRECTOR
4947 EAGLE LANE
WEST BEND WI 53095

Officer/Director/Trustee Three

WAYNE VANGELDEREN
DIRECTOR
W151N5386 BADGER DR
MENOMONEE FALLS WI 55051

Organization’s website WWW.COUNTEDWORTHY.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/23/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
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 No
Financial transactions with officers Yes
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
Signature Title
Signature Date

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