FORM 1023-EZ for FOREST LAKE BOYS CROSS COUNTRY BOOSTER CLUB

Field Data
EIN 84-2242412
Case Number EO-2019182-000757
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOREST LAKE BOYS CROSS COUNTRY BOOSTER CLUB
Organization’s Mailing Address 6101 SCANDIA TRAIL N
City FOREST LAKE
State MN
ZIP 55025-2698
Accounting period End 12
Primary contact name DEANN MAYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JANICE THOMPSON
PRESIDENT
8931 FAWN LAKE DRIVE NE
STACY MN 55079

Officer/Director/Trustee Two

TIA HOUSEMAN
VICE PRESIDENT
1366 14TH AVENUE SE
FOREST LAKE MN 55025

Officer/Director/Trustee Three

CHERIE LARSON
SECRETARY
7740 209TH STREET N
FOREST LAKE MN 55025

Officer/Director/Trustee Four

DEANN MAYER
TREASURER
20083 FARNHAM AVENUE N
FOREST LAKE MN 55025-9812

Organization’s website
Organization’s email FLBCC.BOOSTERCLUB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/27/19
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 DEANN MAYER
Signature Title TREASURER
Signature Date 6/29/19

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