FORM 1023-EZ for BLAINE HAM LAKE ROTARY FOUNDATION INC

Field Data
EIN 81-1648004
Case Number EO-2016081-000104
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLAINE HAM LAKE ROTARY FOUNDATION INC
Organization’s Mailing Address 2035 E COUNTY ROAD D SUITE A
City MAPLEWOOD
State MN
ZIP 55109
Accounting period End 6
Primary contact name STEVEN HELSETH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BEN BINA
PRESIDENT, DIRECTOR
9316 JAMESTOWN STREET NE
BLAINE MN 55449

Officer/Director/Trustee Two

STEVEN HELSETH
VP, SECRETARY, DIRECTOR
2851 - 128TH AVENUE NE
BLAINE MN 55449

Officer/Director/Trustee Three

DEAN RICHARDS
TREASURER
2035 E COUNTY ROAD D SUITE A
MAPLEWOOD MN 55109

Officer/Director/Trustee Four

CATHY MONTAIN
DIRECTOR
1160 CONSTANCE BOULEVARD NE
HAM LAKE MN 55304

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/17/2016
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 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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