FORM 1023-EZ for EMERGE INC

Field Data
EIN 90-0635627
Case Number EO-2015096-000236
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMERGE INC
Organization’s Mailing Address 8108 BRIARWOOD DR
City EVANSVILLE
State IN
ZIP 47715
Accounting period End 12
Primary contact name KEITH ROBINSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KEITH ROBINSON
PRESIDENT
8108 BRIARWOOD DR
EVANSVILLE IN 47715

Officer/Director/Trustee Two

SAMANTHA ROBINSON
TREASURER
8108 BRIARWOOD DR
EVANSVILLE IN 47715

Officer/Director/Trustee Three

KEATON EILERS
SECRETARY
320 SW 7TH STREET APT 308
DES MOINES IA 50309

Organization’s website WWW.EMERGEXPERIENCE.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2010
Organization Incorporation State IN
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 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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