FORM 1023-EZ for POWER HOUSE YOUTH CENTER INC

Field Data
EIN 81-3354526
Case Number EO-2016305-000157
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name POWER HOUSE YOUTH CENTER INC
Organization’s Mailing Address N3963 COUNTY ROAD I
City TONY
State WI
ZIP 54563
Accounting period End 12
Primary contact name LANITA STUTZMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATY JOLES
PRESIDENT
PO BOX 334
LADYSMITH WI 54848

Officer/Director/Trustee Two

JEREMY ALLARD
VICE PRESIDENT
PO BOX 86
SHELDON WI 54766

Officer/Director/Trustee Three

WAYNE ZILLMER
SECRETARY
N4825 TAYLOR ROAD
LADYSMITH WI 54848

Officer/Director/Trustee Four

DONNA WISHOWSKI
TREASURER
622 1ST STREET S
LADYSMITH WI 54848

Officer/Director/Trustee Five

BRENDA HOLMAN
DIRECTOR
N5023 W 9TH STREET N
LADYSMITH WI 54848

Organization’s website
Organization’s email NITAJSMAN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2016
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development 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 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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