FORM 1023-EZ for MONROE COUNTY COMMLUNITY HEALTH ORGANIZATION

Field Data
EIN 83-3692163
Case Number EO-2020184-000317
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MONROE COUNTY COMMLUNITY HEALTH ORGANIZATION
Organization’s Mailing Address PO BOX 273
City SPARTA
State WI
ZIP 54656
Accounting period End 12
Primary contact name MAUREEN SULLIVAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBRA SMITH
PRESIDENT
1608 S HIGHLAND DR
SPARTA WI 54656

Officer/Director/Trustee Two

MAUREEN SULLIVAN
TREASURER
2347 JULIE AVE APT 10
SPARTA WI 54656

Officer/Director/Trustee Three

LYNN EDWARDS
SECRETARY
1411 WEST MONTGOMERY
SPARTA WI 54656

Officer/Director/Trustee Four

KATHLEEN SNOW
VICE-PRESIDENT
1515 S HIGHLAND DR
SPARTA WI 54656

Officer/Director/Trustee Five

MICHAEL PACE
DIRECTOR
1301 NORTH ST
SPARTA WI 54656

Organization’s website
Organization’s email SCHAUERSULLIVAN@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/22/2019
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund 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 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 MAUREEN SULLIVAN
Signature Title TREASURER
Signature Date 6/30/2020

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