FORM 1023-EZ for DOWN SYNDROME ASSOCIATION OF WI INC- CHILDREN OF THE HEART-LACROSSE

Field Data
EIN 46-2581316
Case Number EO-2017150-000137
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DOWN SYNDROME ASSOCIATION OF WI INC- CHILDREN OF THE HEART-LACROSSE
Organization’s Mailing Address 11709 W CLEVELAND AVE SUITE 2
City WEST ALLIS
State WI
ZIP 53227
Accounting period End 12
Primary contact name BRAD VOGHT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KERRY LAURIN
PRESIDENT
11709 W CLEVELAND AVE SUITE 2
WEST ALLIS WI 53227

Officer/Director/Trustee Two

JIM FACKELMAN
VICE PRESIDENT
11709 W CLEVELAND AVE SUITE 2
WEST ALLIS WI 53227

Officer/Director/Trustee Three

RICHARD SCHUTTE
TREASURER
11709 W CLEVELAND AVE SUITE 2
WEST ALLIS WI 53227

Officer/Director/Trustee Four

ANDREW GERBITZ
SELF-ADVOCATE
11709 W CLEVELAND AVE SUITE 2
WEST ALLIS WI 53227

Officer/Director/Trustee Five

DAWN NUOFFER
EXECUTIVE DIRECTOR
11709 W CLEVELAND AVE SUITE 2
WEST ALLIS WI 53227

Organization’s website WWW.DSAW.ORG
Organization’s email INFO@DSAWLACROSSE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2013
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G25 - Down Syndrome
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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