FORM 1023-EZ for PELICAN PIN EM CLUB INC

Field Data
EIN 87-2122783
Case Number EO-2021263-000139
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PELICAN PIN EM CLUB INC
Organization’s Mailing Address 25233 STATE HIGHWAY 108
City PELICAN RAPIDS
State MN
ZIP 56572-7722
Accounting period End 12
Primary contact name CHAD MILLER - ATTORNEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN NORTON
PRESIDENT
25233 STATE HIGHWAY 108
PELICAN RAPIDS MN 56572-7722

Officer/Director/Trustee Two

AARON KAPENGA
VICE PRESIDENT
21824 COUNTY HIGHWAY 20
DETROIT LAKES MN 56501-7065

Officer/Director/Trustee Three

SAMUEL MILBECK
SECRETARY
21153 450TH STREET
PELICAN RAPIDS MN 56572-7337

Officer/Director/Trustee Four

KELLY PEASLEY
TREASURER
34860 COUNTY HIGHWAY 27
ERHARD MN 56534-9541

Officer/Director/Trustee Five

MARK JOHNSON
DIRECTOR
44229 MONUMENT BEACH LOOP
PELICAN RAPIDS MN 56572-7316

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/11/2021
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 JOHN NORTON
Signature Title PRESIDENT
Signature Date 9/16/2021

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