FORM 1023-EZ for BOYS AND GIRLS CLUB OF LODGE GRASS

Field Data
EIN 83-2513497
Case Number EO-2018346-000199
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BOYS AND GIRLS CLUB OF LODGE GRASS
Organization’s Mailing Address 112 HESTER PO BOX 225
City LODGE GRASS
State MT
ZIP 59050
Accounting period End 12
Primary contact name COLLENA BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

COLLENA BROWN
CEO
112 HESTER
LODGE GRASS MT 59050

Officer/Director/Trustee Two

MARK SALLEE
CHAIRMAN
10516 LONGFIELD DR
HUNTLEY IL 60142

Officer/Director/Trustee Three

APRIL TOINETTA
V CHAIR
PO BOX 849
CROW AGENCY MT 59022

Officer/Director/Trustee Four

WARREN TRITSCHLER
TREASURER
PO BOX 565
LODGE GRASS MT 59050

Officer/Director/Trustee Five

TIFFANY DABNEY
SECRETARY
PO BOX 158
LODGE GRASS MT 59050

Organization’s website N/A
Organization’s email CBROWNBGCLG@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/18
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O23 - Boys and Girls Clubs (Combined)
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 COLLENA BROWN
Signature Title CEO
Signature Date 12/10/18

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