FORM 1023-EZ for CARDIN ADULT FAMILY HOME AND FOSTERHOME INC

Field Data
EIN 83-1536491
Case Number EO-2018247-000763
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CARDIN ADULT FAMILY HOME AND FOSTERHOME INC
Organization’s Mailing Address 604 PRAIRIE COURT
City MT HOREB
State WI
ZIP 53572-2293
Accounting period End 12
Primary contact name KATRINA G CARDIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATRINA CARDIN
PRESIDENT/OWNER
604 PRAIRIE COURT
MT HOREB WI 53572-2293

Officer/Director/Trustee Two

PAUL LADWIG
VICE PRESIDENT
3218 DAVIDSON ST
CROSS PLAINS WI 53528

Officer/Director/Trustee Three

AMY SCHURHAMMER
SECRETARY
7201 TEMPE DRIVE
MADISON WI 53719

Organization’s website
Organization’s email CARDINAFH@CHARTER.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/18
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P32 - Foster Care
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 No
Correctness Declaration Yes
Signature Name KATRINA CARDIN
Signature Title PRESIDENT/OWNER
Signature Date 9/1/18

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