FORM 1023-EZ for NORTH COUNTRY MINISTRY OUTREACH INC

Field Data
EIN 83-2323320
Case Number EO-2019059-000317
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTH COUNTRY MINISTRY OUTREACH INC
Organization’s Mailing Address PO BOX 1038 15733 W COUNTY HWY B
City HAYWARD
State WI
ZIP 54843-1038
Accounting period End 12
Primary contact name TIMOTHY WARNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TIMOTHY WARNER
PRESIDENT
10293 S MICHIGAN AVE
HAYWARD WI 54843

Officer/Director/Trustee Two

ROY PETERSON
VICE PRESIDENT
824 HARBOR BEACH CT
HENDERSON NV 89002

Officer/Director/Trustee Three

SANDRA WARNER
SECRETARY
10293 S MICHIGAN AVE
HAYWARD WI 54843

Officer/Director/Trustee Four

JULIE GASKILL
TREASURER
16158 W DEER LN
HAYWARD WI 54843

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/12/18
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: 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 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 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 TIMOTHY WARNER
Signature Title PRESIDENT
Signature Date 2/26/19

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