FORM 1023-EZ for CYGNET SCHOLARSHIP FOUNDATION

Field Data
EIN 84-2233316
Case Number EO-2019252-000156
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CYGNET SCHOLARSHIP FOUNDATION
Organization’s Mailing Address 1222 WELCOME DRIVE
City LONG LAKE
State MN
ZIP 55356
Accounting period End 12
Primary contact name JIM TIERNEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MAURA TIERNEY
VICE CHAIRMAN, DIRECTOR
1222 WELCOME DRIVE
LONG LAKE MN 55356

Officer/Director/Trustee Two

MARY KELLY KADLEC
CHAIRMAN, DIRECTOR
16425 76TH PLACE N
MAPLE GROVE MN 55311

Officer/Director/Trustee Three

ROGER KADLEC
SECRETARY, DIRECTOR
16425 76TH PLACE N
MAPLE GROVE MN 55311

Officer/Director/Trustee Four

JIM TIERNEY
TREASURER, DIRECTOR
1222 WELCOME DRIVE
LONG LAKE MN 55356

Officer/Director/Trustee Five

ROBB SMITH
DIRECTOR
3801 SOUTH ACACIA COURT
CHANDLER AZ 85248

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/21/19
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
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 Yes
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 JIM TIERNEY
Signature Title TREASURER, DIRECTOR
Signature Date 9/5/19

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