FORM 1023-EZ for GRANT COUNTY HUMANE SOCIETY INC

Field Data
EIN 47-4143085
Case Number EO-2015155-000173
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GRANT COUNTY HUMANE SOCIETY INC
Organization’s Mailing Address 222 SOUTH ROOSEVELT STREET
City LANCASTER
State WI
ZIP 53813
Accounting period End 6
Primary contact name DEE ROWE - ATTORNEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

HELEN ANDERSON
DIRECTOR
11151 BORAH ROAD
LANCASTER WI 53813

Officer/Director/Trustee Two

CARI SCHAFFER
DIRECTOR
222 SOUTH ROOSEVELT STREET
LANCASTER WI 53813

Officer/Director/Trustee Three

BRAD BINSFELD
DIRECTOR
4905 AIRPORT ROAD
LANCASTER WI 53813

Officer/Director/Trustee Four

KATHLEEN DITMANSON ADAMS
DIRECTOR
10981 MARIAN ROAD
LANCASTER WI 53813

Officer/Director/Trustee Five

MELISSA KARPEL
DIRECTOR
4905 AIRPORT ROAD
LANCASTER WI 53813

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
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
Signature Title
Signature Date

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