FORM 1023-EZ for PREGNANCY SUPPORT CENTER OF DODGE COUNTY INC

Field Data
EIN 46-1738683
Case Number EO-2016232-000457
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PREGNANCY SUPPORT CENTER OF DODGE COUNTY INC
Organization’s Mailing Address 108 PARALLEL STREET
City BEAVER DAM
State WI
ZIP 53916
Accounting period End 12
Primary contact name KRYS CRAWLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUDY JOHNSEN
BOARD PRESIDENT
313 EMILY LANE
BEAVER DAM WI 53916-1991

Officer/Director/Trustee Two

RANDY RICHARD
BOARD VICE PRESIDENT
W7668 DANIELLE DR
BEAVER DAM WI 53916-1991

Officer/Director/Trustee Three

SHARON KALINOSKY
TREASURER
105 EDGEVALE CIRCLE
BEAVER DAM WI 53916-1991

Officer/Director/Trustee Four

JOHN ZANGHI
SECRETARY
133 WARREN ST
BEAVER DAM WI 53916-1991

Officer/Director/Trustee Five

KRYS CRAWLEY
EXECUTIVE DIRECTOR
S92 W32010 HWY NN
MUKWONAGO WI 53149-9031

Organization’s website WWW.PSCDCI.COM
Organization’s email INFO@PSCDCI.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/11/2012
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y11 - Single Organization Support
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 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
Signature Title
Signature Date

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