FORM 1023-EZ for FOX VALLEY HEALTH PROFESSIONALS INC

Field Data
EIN 39-2022841
Case Number EO-2014342-000332
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FOX VALLEY HEALTH PROFESSIONALS INC
Organization’s Mailing Address 3508 N MARIAH LANE
City APPLETON
State WI
ZIP 54911
Accounting period End 12
Primary contact name JAMES RUDD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CATHY SHINE
PRESIDENT AND DIRECTOR
3508 N MARIAH LANE
APPLETON WI 54911

Officer/Director/Trustee Two

BRIDGET HUENINK
VICE PRESIDENT AND DIRECTOR
2801 E GLENHURST LANE
APPLETON WI 54913

Officer/Director/Trustee Three

DANIELLE VANEVENHOVEN
SECRETARY AND DIRECTOR
102 FAIRWAY STREET
COMBINED LOCKS WI 54113

Officer/Director/Trustee Four

PEGGY FLEASE
TREASURER AND DIRECTOR
W9559 CLOVERLEAF ROAD
HORTONVILLE WI 54944

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/14/2005
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G03 - Professional Societies, Associations
Organization’s purpose Charitable: No
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
Signature Title
Signature Date

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