FORM 1023-EZ for SIOUXPERCON

Field Data
EIN 47-5264284
Case Number EO-2017125-000335
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SIOUXPERCON
Organization’s Mailing Address 2907 S DULUTH AVENUE
City SIOUX FALLS
State SD
ZIP 57105
Accounting period End 5
Primary contact name BRIAN BROEKEMEIER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN BROEKEMEIER
CHAIRMAN/DIRECTOR
2907 S DULUTH AVENUE
SIOUX FALLS SD 57105

Officer/Director/Trustee Two

JOSH JURGENS
DIRECTOR
429 S WILLOW AVENUE
SIOUX FALLS SD 57104

Officer/Director/Trustee Three

JOSEPH EKTNITPHONG
SECRETARY/DIRECTOR
805 E RYAN DRIVE APT 7
TEA SD 57064

Officer/Director/Trustee Four

DANI FRANSEEN
TREASURER/DIRECTOR
805 E RYAN DRIVE APT 7
TEA SD 57064

Officer/Director/Trustee Five

SHANE GERLACH
VICE CHAIRMAN/DIRECTOR
718 4TH STREET
DELL RAPIDS SD 57022

Organization’s website WWW.SIOUXPERCON.COM
Organization’s email ADMIN@SIOUXPERCON.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/2016
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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