FORM 1023-EZ for TRIAD OF WALWORTH COUNTY INC
| Field | Data |
|---|---|
| EIN | 83-4504455 |
| Case Number | EO-2019329-000214 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | TRIAD OF WALWORTH COUNTY INC |
| Organization’s Mailing Address | 506 EAST GENEVA STREET |
| City | DELAVAN |
| State | WI |
| ZIP | 53115 |
| Accounting period End | 12 |
| Primary contact name | MELISSA DAVIS |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
MELISSA DAVIS
CHAIRPERSON
506 EAST GENEVA STREET
DELAVAN WI 53115-2214
Officer/Director/Trustee Two
TROY PAGENKOPF
VICE CHAIRPERSON
WCSO 1770 COUNTY RD NN
ELKHORN WI 53121-4454
Officer/Director/Trustee Three
JEANINE DABLE
SECRETARY
ADRC W4051 COUNTY RD NN
ELKHORN WI 53121-4454
Officer/Director/Trustee Four
HEATHER CRABTREE
TREASURER
716 LAMAR DR
MILTON WI 53563-1003
Officer/Director/Trustee Five
CAROLE COCCIA
SENIOR COMMUNITY MEMBER
3554 WESTSHIRE CIRCLE
DELAVAN WI 53115-4234
| Organization’s website | WWW.FACEBOOK.COM/WALCOTRIAD/ |
|---|---|
| Organization’s email | CHAIRPERSON@SEWISTRIAD.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 11/16/19 |
| Organization Incorporation State | WI |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | P01 - Alliance/Advocacy Organizations |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes Scientific: No Literary: No Public Safety: Yes 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 | MELISSA DAVIS |
| Signature Title | CHAIRPERSON |
| Signature Date | 11/21/19 |
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