FORM 1023-EZ for SARGENT COUNTY FOOD PANTRY

Field Data
EIN 32-0163793
Case Number EO-2017317-000415
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SARGENT COUNTY FOOD PANTRY
Organization’s Mailing Address PO BOX 101
City FORMAN
State ND
ZIP 58032-0101
Accounting period End 12
Primary contact name NICK STORHAUG CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VAL BJORK
PRESIDENT
8606 134TH AVE SE
FORMAN ND 58032

Officer/Director/Trustee Two

KYLA TEMPLE
VICE-PRESIDENT
303 ANTHONY ST
RUTLAND ND 58067

Officer/Director/Trustee Three

RENEE LARSON
SECRETARY
219 LYLAC CIRCLE
FORMAN ND 58032

Officer/Director/Trustee Four

LONNIE HOECHST
TREASURER
4 2ND ST NE
GWINNER ND 58040

Officer/Director/Trustee Five

CHERYL WYCKOFF
FOOD PANTRY COORDINATOR
223 MAPLE AVE W
FORMAN ND 58032

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2014
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P60 - Emergency Assistance (Food, Clothing, Cash)
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 Yes
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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