FORM 1023-EZ for FOUNTAIN CITY MEDICAL EMERGENCY TEAM INC

Field Data
EIN 39-1906376
Case Number EO-2016077-000126
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FOUNTAIN CITY MEDICAL EMERGENCY TEAM INC
Organization’s Mailing Address S2972 WAUMANDEE CREEK ROAD
City FOUNTAIN CITY
State WI
ZIP 54629-7828
Accounting period End 12
Primary contact name CLEO LOSINSKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JENNIFER CONNERS
PRESIDENT
348 SOUTH MAIN ST
FOUNTAIN CITY WI 54629-7828

Officer/Director/Trustee Two

JOHN LOSINSKI
VICE PRESIDEN
S2972 WAUMANDEE CREEK ROAD
FOUNTAIN CITY WI 54629-7828

Officer/Director/Trustee Three

FAYE CONNERS
SECRETARY
348 SOUTH MAIN ST
FOUNTAIN CITY WI 54629-7828

Officer/Director/Trustee Four

CLEO LOSINSKI
TREASURER
S2972 WAUMANDEE CREEK ROAD
FOUNTAIN CITY WI 54629-7828

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2010
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E21 - Community Health Systems
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 Yes
One Third Support Gifts No
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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