FORM 1023-EZ for BEREAVED PARENTS OF MADISON INC

Field Data
EIN 47-4015715
Case Number EO-2015166-000400
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BEREAVED PARENTS OF MADISON INC
Organization’s Mailing Address PO BOX 46511
City MADISON
State WI
ZIP 53744-6511
Accounting period End 12
Primary contact name CLAIRE MATEJKA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CLAIRE MATEJKA
PRESIDENT
238 GRAND CANYON DRIVE
MA WI 53705

Officer/Director/Trustee Two

JEN PEPOY
SECRETARY
720 CLEDELL ST
OREGON WI 53575

Officer/Director/Trustee Three

EMILY GRORUD
TREASURER
502 PIPER DR
MADISON WI 53711

Organization’s website WWW.BEREAVEDPARENTSOFMADISON.COM
Organization’s email BEREAVEDPARENTSOFMADISON@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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