FORM 1023-EZ for HOST A FAMILY

Field Data
EIN 39-1924661
Case Number EO-2016277-000287
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOST A FAMILY
Organization’s Mailing Address PO BOX 295
City STOUGHTON
State WI
ZIP 53589-0295
Accounting period End 1
Primary contact name KAY WEEDEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN SCHADEWALD
COORDINATOR
2005 SKAALEN RD
STOUGHTON WI 53589

Officer/Director/Trustee Two

LAURA ROEVEN
TREASURER
321 LOWELL ST
STOUGHTON WI 53589

Officer/Director/Trustee Three

SHARON MASON BOERSMA
MEMBER
243 MCKINLEY ST
STOUGHTON WI 53589

Officer/Director/Trustee Four

KAY WEEDEN
MEMBER
126 MANILLA ST
STOUGHTON WI 53589

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/28/2004
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P58 - Gift 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 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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