FORM 1023-EZ for JAYNA KELLEY MEMORIAL FOUNDATION LTD

Field Data
EIN 83-4283425
Case Number EO-2019364-000291
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JAYNA KELLEY MEMORIAL FOUNDATION LTD
Organization’s Mailing Address 4628 144TH STREET
City CHIPPEWA FALLS
State WI
ZIP 54729-4859
Accounting period End 12
Primary contact name BRIAN KELLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN KELLEY
PRESIDENT
4628 144TH STREET
CHIPPEWA FALLS WI 54729-4859

Officer/Director/Trustee Two

MEGAN BOLLMAN
VICE PRESIDENT
E8610 643RD AVENUE
ELK MOUND WI 54739-9276

Officer/Director/Trustee Three

ROBIN KELLEY
SECRETARY/TREASURER
4628 144TH STREET
CHIPPEWA FALLS WI 54729-4859

Officer/Director/Trustee Four

HEIDI FRANK
DIRECTOR
3344 POTTER ROAD
EAU CLAIRE WI 54703-1114

Officer/Director/Trustee Five

RYAN WUNDROW
DIRECTOR
402 PINE COURT
STANLEY WI 54768-1289

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/4/2019
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 BRIAN KELLEY
Signature Title PRESIDENT
Signature Date 12/27/2019

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