FORM 1023-EZ for GLEN AVON HOCKEY FOUNDATION

Field Data
EIN 84-2096902
Case Number EO-2019176-000453
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GLEN AVON HOCKEY FOUNDATION
Organization’s Mailing Address PO BOX 3505
City DULUTH
State MN
ZIP 55803
Accounting period End 6
Primary contact name NICK LICARI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NICK LICARI
TREASURER
PO BOX 3505
DULUTH MN 55803

Officer/Director/Trustee Two

BRAD ORN
DIRECTOR
PO BOX 3505
DULUTH MN 55803

Officer/Director/Trustee Three

BURKE EDGERTON
DIRECTOR
PO BOX 3505
DULUTH MN 55803

Officer/Director/Trustee Four

JUSTIN BLACK
DIRECTOR
PO BOX 3505
DULUTH MN 55804

Officer/Director/Trustee Five

RAY PETERSON
DIRECTOR
PO BOX 3505
DULUTH MN 55803

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/20/19
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N68 - Winter Sports (Snow and Ice)
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name NICK LICARI
Signature Title TREASURER
Signature Date 6/21/19

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