FORM 1023-EZ for WAVERLY AMBASSADOR PROGRAM

Field Data
EIN 85-0729514
Case Number EO-2020269-000440
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WAVERLY AMBASSADOR PROGRAM
Organization’s Mailing Address 4359 70TH ST SW
City WAVERLY
State MN
ZIP 55390
Accounting period End 12
Primary contact name LYNN BORRELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LYNN BORRELL
COMMITTEE MEMBER
4359 70TH ST SW
WAVERLY MN 55390

Officer/Director/Trustee Two

SHANIAH KARELS
COMMITTEE MEMBER
QUIST AVE SW
COKATO MN 55321

Officer/Director/Trustee Three

SHERRY HOILAND
COMMITTEE MEMBER
5289 AETNA AVE
MONTROSE MN 55363

Officer/Director/Trustee Four

SHELBY OGLE
COMMITTEE MEMBER
PO BOX 37
WAVERLY MN 55390

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/8/2019
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S40 - Business and Industry
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LYNN BORRELL
Signature Title COMMITTEE MEMBER
Signature Date 9/23/2020

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