FORM 1023-EZ for HOCKEY MOMS USA

Field Data
EIN 45-5137009
Case Number EO-2015363-000047
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOCKEY MOMS USA
Organization’s Mailing Address PO BOX 270681
City VADNAIS HEIGHTS
State MN
ZIP 55127
Accounting period End 12
Primary contact name BECKI BOLDT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BECKI BOLDT
PRESIDENT
4780 CENTERVILLE RD APT 119
VADNAIS HEIGHTS MN 55127

Officer/Director/Trustee Two

TANYA HARRELSON
SECRETARY
2921 HADLEY AVENUE
OAKDALE MN 55128

Officer/Director/Trustee Three

CHARLES LARSON
TREASURER
3105 LANDING LANE
CORAOPOLIS PA 15108

Officer/Director/Trustee Four

KEVIN PRIBYL
PUBLIC RELATIONS DIRECTOR
13939 IRONSTONE TRAIL
RAMSEY MN 55303

Officer/Director/Trustee Five

MELISSA RIST
VICE PRESIDENT
1504 GREELEY AVENUE SOUTH APT 2
STILLWATER MN 55082

Organization’s website WWW.HOCKEYMOMSUSA.ORG
Organization’s email HOCKEYMOMSUSA@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/19/2012
Organization Incorporation State MN
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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
Signature Title
Signature Date

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