FORM 1023-EZ for UPPER ROOM COUNSELING INC

Field Data
EIN 84-2920871
Case Number EO-2020023-000392
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name UPPER ROOM COUNSELING INC
Organization’s Mailing Address 13121 COUNTY ROAD 16
City BLAIR
State NE
ZIP 68008
Accounting period End 12
Primary contact name MARK ZANOTTO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KIRK HUTTON
DIRECTOR/PRESIDENT
1900 ARBOR CIR
BLAIR NE 68008

Officer/Director/Trustee Two

MARK ZANOTTO
DIRECTOR/TREASURER
1759 WILBUR ST
BLAIR NE 68008

Officer/Director/Trustee Three

GLEN HUDSON
DIRECTOR/SECRETARY
101 RIVERVIEW DR
BLAIR NE 68008

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/3/2019
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 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 KIRK HUTTON
Signature Title DIRECTOR/PRESIDENT
Signature Date 1/21/2020

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