FORM 1023-EZ for ROTARY CLUB OF LAGRANGE ILLINOIS FOUNDATION

Field Data
EIN 82-1961487
Case Number EO-2017188-000169
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROTARY CLUB OF LAGRANGE ILLINOIS FOUNDATION
Organization’s Mailing Address 7500 COUNTY LINE RD
City BURR RIDGE
State IL
ZIP 60527
Accounting period End 6
Primary contact name KEN DAEMICKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RANDY KING
PRESIDENT
506 PARK
LAGRANGE PARK IL 60526

Officer/Director/Trustee Two

FLORENCE FORSHEY
SECRETARY
1001 S WAIOLA
LAGRANGE IL 60525

Officer/Director/Trustee Three

JOE KROC
TREASURER
2308 S 8TH AVE
NORTH RIVERSIDE IL 60546

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/16/2017
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W12 - Fund Raising and/or Fund Distribution
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 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
Signature Title
Signature Date

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