FORM 1023-EZ for JACKSON COUNTY HUMANE SOCIETY INC

Field Data
EIN 39-1368939
Case Number EO-2015057-000095
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JACKSON COUNTY HUMANE SOCIETY INC
Organization’s Mailing Address 207 HARRISON ST
City BLACK RIVER FALLS
State WI
ZIP 54615-1318
Accounting period End 12
Primary contact name JOHN LUND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MERLY DIVVER
PRESIDENT
N9274 POWER HOUSE RD
BLACK RIVER FALLS WI 54615

Officer/Director/Trustee Two

LISA DRINKMAN
VCPRES
N5785 RIVER DRIVE
BLACK RIVERFALLS WI 54615

Officer/Director/Trustee Three

ELIZABETH LUND
TREAS.
207 HARRISON ST
BLACK RIVER FALLS WI 54615

Officer/Director/Trustee Four

LEE MCLAUGHLIN
SEC
W10219 KENNY RD
BLACK RIVER FALLS WI 54615

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/14/1980
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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