FORM 1023-EZ for SARAH EISBERNER MEMORIAL SCHOLARSHIP INC

Field Data
EIN 47-4269184
Case Number EO-2015175-000330
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SARAH EISBERNER MEMORIAL SCHOLARSHIP INC
Organization’s Mailing Address N4398 US HIGHWAY 12
City HUMBIRD
State WI
ZIP 54746-8009
Accounting period End 12
Primary contact name KATHLEEN HARASIMOWICZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KATHLEEN HARASIMOWICZ
PRESIDENT, DIRECTOR
N4398 US HIGHWAY 12
HUMBIRD WI 54746-8009

Officer/Director/Trustee Two

CHRISTINA COLLINS
TREASURER, DIRECTOR
N4181 STUVE ROAD
HUMBIRD WI 54746-8009

Officer/Director/Trustee Three

SHAWN CALLISTO
SECRETARY, DIRECTOR
5935 MARTS ROAD
BLACK RIVER FALLS WI 54615-6036

Organization’s website
Organization’s email KRHARAS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/8/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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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