FORM 1023-EZ for COMMUNITY HEALTH SERVICES FOUNDATION INC
| Field | Data |
|---|---|
| EIN | 81-4044374 |
| Case Number | EO-2017261-000240 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | COMMUNITY HEALTH SERVICES FOUNDATION INC |
| Organization’s Mailing Address | 720 SOUTH FREMONT STREET |
| City | PRAIRIE DU CHIEN |
| State | WI |
| ZIP | 53821-2387 |
| Accounting period End | 6 |
| Primary contact name | ALESHA ERDENBERGER |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JOYCE CZAJKOWSKI
CHAIR DIRECTOR
33396 POLLANDER ROAD
WAUZEKA WI 53826-8691
Officer/Director/Trustee Two
MARY CONNIE ACHENBACH
SECRETARY DIRECTOR
62555 CARRIAGE CIRCLE
PRAIRIE DU CHIEN WI 53821-8051
Officer/Director/Trustee Three
JOSEPH ATKINS
TREASURER DIRECTOR
1110 EAST IOWA STREET
PRAIRIE DU CHIEN WI 53821-1815
| Organization’s website | WWW.CHSCWI.ORG |
|---|---|
| Organization’s email | AME@CHSCWI.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 3/20/2017 |
| Organization Incorporation State | WI |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E99 - Health - General and Rehabilitative N.E.C. |
| Organization’s purpose | Charitable: Yes 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 | 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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