FORM 1023-EZ for MID MISSOURI RIVER PRESCRIBED BURN ASSOCIATION

Field Data
EIN 81-1370825
Case Number EO-2017030-000193
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MID MISSOURI RIVER PRESCRIBED BURN ASSOCIATION
Organization’s Mailing Address 35801 OLD 1806TH ROAD
City BONESTEEL
State SD
ZIP 57317-5374
Accounting period End 12
Primary contact name BRAD CHRISTENSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEITH HOVORKA
CHAIRMAN
100 CLEVELAND AVE
FAIRFAX SD 57335

Officer/Director/Trustee Two

DAVE STEFFEN
VICE-CHAIRMAN
34110 294TH STQ
BURKE SD 57523-5105

Officer/Director/Trustee Three

SARA GRIM
SECRETARY/TREASURER
35801 OLD 1806TH ROAD
BONESTEEL SD 57317-5374

Officer/Director/Trustee Four

BRAD CHRISTENSEN
TRAINING OFFICER
1022 WHITTECAR AVE
GREGORY SD 57533-1038

Officer/Director/Trustee Five

CHAD BENTZ
DIRECTOR
39276 299TH ST
BONESTEEL SD 57317-5315

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/23/2016
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C34 - Land Resources Conservation
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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