FORM 1023-EZ for WISCONSIN HOSPICE AND PALLIATIVE CARE ASSOCIATION INC

Field Data
EIN 83-3382962
Case Number EO-2019065-000374
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WISCONSIN HOSPICE AND PALLIATIVE CARE ASSOCIATION INC
Organization’s Mailing Address 5395 E CHERYL PKWY
City MADISON
State WI
ZIP 53711
Accounting period End 12
Primary contact name DOUGLAS A PESSEFALL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LYNNE SEXTEN
CHAIR
5395 E CHERYL PKWY
MADISON WI 53711

Officer/Director/Trustee Two

ALISA GERKE
VICE CHAIR
5395 E CHERYL PKWY
MADISON WI 53711

Officer/Director/Trustee Three

ERIC TETZLAFF
SECRETARY
5395 E CHERYL PKWY
MADISON WI 53711

Officer/Director/Trustee Four

RYAN KLAUSTERMEIER
TREASURER
5395 E CHERYL PKWY
MADISON WI 53711

Organization’s website
Organization’s email LYNNE.SEXTEN@AGRACE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/30/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence Yes
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 LYNNE SEXTEN
Signature Title CHAIR
Signature Date 3/4/19

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