FORM 1023-EZ for COMMUNITY SENIOR DAY STAY

Field Data
EIN 83-1926840
Case Number EO-2019317-000150
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY SENIOR DAY STAY
Organization’s Mailing Address PO BOX 304
City JOHNSTOWN
State CO
ZIP 80534
Accounting period End 12
Primary contact name NICOLE ABRAHAMSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CANDI WINCKEL
PRESIDENT
1544 GOLDENEYE DR
JOHNSTOWN CO 80534

Officer/Director/Trustee Two

SILVIA REGENSBURGER
VICE PRESIDENT
2814 BLUE ACONA WAY
JOHNSTOWN CO 80534

Officer/Director/Trustee Three

MICHAEL WALES
SECRETARY
26697 CR 15
JOHNSTOWN CO 80534

Officer/Director/Trustee Four

SUSAN KUHN
TREASURER
1122 26TH AVE NE
OLYMPIA WA 98506

Organization’s website
Organization’s email COMMUNITYSENIORDAYSTAY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/17/18
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P75 - Senior Continuing Care Communities
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 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 CANDI WINCKEL
Signature Title PRESIDENT
Signature Date 11/11/19

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