FORM 1023-EZ for MINING IMPACT COALITION OF WISCONSIN INC

Field Data
EIN 39-1800049
Case Number EO-2020086-000145
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MINING IMPACT COALITION OF WISCONSIN INC
Organization’s Mailing Address 3918 PAUNACK AVE
City MADISON
State WI
ZIP 53711
Accounting period End 12
Primary contact name DAVE BLOUIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID BLOUIN
COORDINATOR
3918 PAUNACK AVE
MADISON WI 53711-1623

Officer/Director/Trustee Two

FRANK KOEHN
PRESIDENT
619 17TH AVE W
ASHLAND WI 54806

Officer/Director/Trustee Three

PETE RASMUSSEN
VICE PRESIDENT
69248 PETERSON RD
MARENGO WI 54855

Officer/Director/Trustee Four

SANDY GOKEE
SECRETARY
901 10TH AVE W
ASHLAND WI 54806

Officer/Director/Trustee Five

BILL HEART
TREASURER
29450 WERNER RD
ASHLAND WI 54806

Organization’s website NA
Organization’s email BURROAK15@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/1995
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C99 - Environmental Quality, Protection, and Beautification N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DAVID BLOUIN
Signature Title COORDINATOR
Signature Date 3/24/2020

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