FORM 1023-EZ for BLUE LINE CHAPLAINS INC

Field Data
EIN 81-2444278
Case Number EO-2019350-000168
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLUE LINE CHAPLAINS INC
Organization’s Mailing Address PO BOX 160
City DEFOREST
State WI
ZIP 53532-9720
Accounting period End 12
Primary contact name ROBERT GOODSELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT GOODSELL
PRESIDENT
313 RIVER WOOD BEND
DEFOREST WI 53532-9720

Officer/Director/Trustee Two

BRADSHAW GOODSELL
VICE PRESIDENT
1S295 S HYDE PARK
GENEVA IL 60134-4810

Officer/Director/Trustee Three

SCOTT GREGORY
SECRETARY
3027 PROVIDENCE ST UNIT 9
SUN PRAIRIE WI 53590-4617

Officer/Director/Trustee Four

CRAIG SHERVAN
TREASURER
3985 MAHONEY ROAD
MCFARLAND WI 53558-9132

Officer/Director/Trustee Five

GARY BASS
AT-LARGE DIRECTOR
8914 SETTLERS RD
MADISON WI 53717-2712

Organization’s website WWW.BLUELINECHAPLAINS.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/2016
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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 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 ROBERT GOODSELL
Signature Title PRESIDENT
Signature Date 12/12/2019
EIN 81-2444278
Case Number EO-2016139-000320
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLUE LINE CHAPLAINS INC
Organization’s Mailing Address 313 RIVER WOOD BEND
City DEFOREST
State WI
ZIP 53532-9720
Accounting period End 12
Primary contact name ROBERT GOODSELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT GOODSELL
DIRECTOR PRESIDENT
313 RIVER WOOD BEND
DEFOREST WI 53532-9720

Officer/Director/Trustee Two

BRADSHAW GOODSELL
DIRECTOR VICE PRESIDENT
1561 RAYMOND ROAD 202
NAPERVILLE IL 60563-9830

Officer/Director/Trustee Three

CRAIG SHERVEN
DIRECTOR TREASURER
5805 JUNIPER RIDGE
MCFARLAND WI 53558-9140

Officer/Director/Trustee Four

SCOTT GREGORY
DIRECTOR SECRETARY
2120 FISH HATCHERY ROAD
MADISON WI 53713-8400

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/2016
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: Yes
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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