FORM 1023-EZ for LODI VALLEY HISTORICAL SOCIETY

Field Data
EIN 23-7311198
Case Number EO-2020003-000156
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LODI VALLEY HISTORICAL SOCIETY
Organization’s Mailing Address PO BOX 72
City LODI
State WI
ZIP 53555-0072
Accounting period End 12
Primary contact name MARY ANN JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AUDREY MCCUBBIN
PRESIDENT
101 D JOYCE DRIVE
LODI WI 53555

Officer/Director/Trustee Two

MONTE THOMPSON
VICE-PRESIDENT
124 MERTON
LODI WI 53555

Officer/Director/Trustee Three

MARY ANN JOHNSON
SECRETARY
W11505 CTR V
LODI WI 53555

Officer/Director/Trustee Four

MICHELLE FITZGERALD
TREASURER
405 PORTAGE STREET
LODI WI 53555

Organization’s website
Organization’s email LVHS173@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/8/1973
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A54 - History Museums
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name MARY ANN JOHNSON
Signature Title SECRETARY
Signature Date 12/31/2019
EIN 23-7311198
Case Number EO-2016362-000371
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LODI VALLEY HISTORICAL SOCIETY INC
Organization’s Mailing Address 173 S MAIN STREET
City LODI
State WI
ZIP 53555-1120
Accounting period End 12
Primary contact name PAUL A JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AUDREY MCCUBBIN
PRESIDENT/DIRECTOR
173 S MAIN STREET
LODI WI 53555-1120

Officer/Director/Trustee Two

MARY ANN JOHNSON
SECRETARY/TREASURER/DIRECTOR
173 S MAIN STREET
LODI WI 53555-1120

Officer/Director/Trustee Three

MONTE THOMPSON
DIRECTOR
173 S MAIN STREET
LODI WI 53555-1120

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/5/1973
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A54 - History Museums
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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