FORM 1023-EZ for THE KEN MELLINGER MEMORIAL FOUNDATION INC

Field Data
EIN 46-4090733
Case Number EO-2015023-000228
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE KEN MELLINGER MEMORIAL FOUNDATION INC
Organization’s Mailing Address 1353 BIG HORN AVE
City SHERIDAN
State WY
ZIP 82801
Accounting period End 8
Primary contact name LESLIE R MELLINGER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LESLIE MELLINGER
PRESIDENT
1353 BIG HORN AVE
SHERIDAN WY 82801

Officer/Director/Trustee Two

DOUG MOORE
VICE PRESIDENT
1803 EDWARDS
SHERIDAN WY 82801

Officer/Director/Trustee Three

ANDREA MELLINGER
TREASURER
2008 LIBERTY COURT
SHERIDAN WY 82801

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/12/2013
Organization Incorporation State WY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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
Signature Title
Signature Date

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