FORM 1023-EZ for IMPACT THEATRE COMPANY

Field Data
EIN 84-4053349
Case Number EO-2020321-000294
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name IMPACT THEATRE COMPANY
Organization’s Mailing Address 104 S MAIN ST STE A
City FOND DU LAC
State WI
ZIP 54935-4269
Accounting period End 12
Primary contact name BRIANA GENS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIANA GENS
MRS
40 E DIVISION ST APT B UP
FOND DU LAC WI 54935-4214

Officer/Director/Trustee Two

NOAH GOEBEL
MR
57 E 12TH ST
FOND DU LAC WI 54935-5036

Officer/Director/Trustee Three

HANNAH HOLZMANN
MS
26 GLENWOOD CT
FOND DU LAC WI 54935-5492

Officer/Director/Trustee Four

ANDREW MUELLER
MR
40 E DIVISION ST APT B UP
FOND DU LAC WI 54935-4214

Officer/Director/Trustee Five

TRAVIS WORTH
MR
1102 N BRIARCLIFF DR
FOND DU LAC WI 54935-2847

Organization’s website
Organization’s email IMPACTFDLTHEATRE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2019
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A65 - Theater
Organization’s purpose Charitable: Yes
Religious: No
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 No
Correctness Declaration Yes
Signature Name BRIANA GENS
Signature Title MRS
Signature Date 11/12/2020

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