FORM 1023-EZ for ST CLARE HEALTH MISSION OF MONROE COUNTY INC
| Field | Data |
|---|---|
| EIN | 84-3749417 |
| Case Number | EO-2019345-000231 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | ST CLARE HEALTH MISSION OF MONROE COUNTY INC |
| Organization’s Mailing Address | 310 WEST MAIN STREET |
| City | SPARTA |
| State | WI |
| ZIP | 54656 |
| Accounting period End | 12 |
| Primary contact name | DEBORAH LUTJEN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
KIMBERLY A HAWTHORNE
DIRECTOR
310 W MAIN STREET
SPARTA WI 54656
Officer/Director/Trustee Two
BEN CRENSHAW
DIRECTOR
310 WEST MAIN STREET
SPARTA WI 54656
Officer/Director/Trustee Three
LORI FERRIES
DIRECTOR
310 WEST MAIN STREET
SPARTA WI 54656
Officer/Director/Trustee Four
KEVIN FITZGERALD
DIRECTOR
310 WEST MAIN STREET
SPARTA WI 54656
Officer/Director/Trustee Five
MICHAEL SAUNDERS
OFFICER
310 WEST MAIN STREET
SPARTA WI 54656
| Organization’s website | WWW.STCLAREMONROECOUNTY.ORG |
|---|---|
| Organization’s email | LUTJEN.DEBORAH@MAYO.EDU |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 10/16/2019 |
| Organization Incorporation State | WI |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E12 - Fund Raising and/or Fund Distribution |
| 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 | MICHAEL SAUNDERS |
| Signature Title | OFFICER |
| Signature Date | 12/9/2019 |
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