FORM 1023-EZ for BEAVER DAM YOUTH SOCCER CLUB INC

Field Data
EIN 27-3896237
Case Number EO-2017130-000303
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BEAVER DAM YOUTH SOCCER CLUB INC
Organization’s Mailing Address W7998 COUNTY ROAD W
City BEAVER DAM
State WI
ZIP 53916
Accounting period End 8
Primary contact name HEIDI ELGERSMA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRUCE KAUFMANN
PRESIDENT
W9368 WENDT DRIVE
BEAVER DAM WI 53916

Officer/Director/Trustee Two

HEIDI ELGERSMA
TREASURER
W7998 COUNTY ROAD W
BEAVER DAM WI 53916

Officer/Director/Trustee Three

CINDY LAUTH
REGISTRAR
N7408 N CRYSTAL LAKE ROAD
BEAVER DAM WI 53916

Officer/Director/Trustee Four

AYSHA DOMINQUEZ
VICE PRESIDENT
W3448 CROWN ROAD
CAMBRIA WI 53923

Officer/Director/Trustee Five

BECKY VAN DUSEN
SECRETARY
612 S LINCOLN AVENUE
BEAVER DAM WI 53916

Organization’s website WWW.BDUSC.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/2010
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
Organization’s purpose Charitable: No
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 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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