FORM 1023-EZ for COMMUNITY KICKING CANCER

Field Data
EIN 84-4470716
Case Number EO-2020153-000106
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY KICKING CANCER
Organization’s Mailing Address 8110 34TH AVE
City SELFRIDGE
State ND
ZIP 58568
Accounting period End 12
Primary contact name GLENDA GROSS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORIE HACH
PRESIDENT
27246 101ST ST
MCLAUGHLIN SD 57642

Officer/Director/Trustee Two

GLENDA GROSS
SECRETARY-TREASURE
8110 34TH AVE
SELFRIDGE ND 58568

Officer/Director/Trustee Three

JUANA GROSS
SECRETARY-TREASURE
3815 80TH ST SW
SHIELDS ND 58569

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2020
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 GLENDA GROSS
Signature Title SECRETARY-TREASURE
Signature Date 5/29/2020

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