FORM 1023-EZ for TRI-COUNTY SPORTSMENS CLUB INC

Field Data
EIN 47-3821438
Case Number EO-2016034-000109
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TRI-COUNTY SPORTSMENS CLUB INC
Organization’s Mailing Address PO BOX 124
City MONTEVIDEO
State MN
ZIP 56265
Accounting period End 12
Primary contact name JAMES B KNUTSON CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JAN PAYNE
PRESIDENT
PO BOX 124
MONTEVIDEO MN 56265

Officer/Director/Trustee Two

LANCE ERICKSON
TREASURER
PO BOX 124
MONTEVIDEO MN 56265

Officer/Director/Trustee Three

STEVE MAUS
VICE-PRESIDENT
PO BOX 124
MONTEVIDEO MN 56265

Officer/Director/Trustee Four

DEREK OLSON
SECRETARY
PO BOX 124
MONTEVIDEO MN 56265

Officer/Director/Trustee Five

MIKE ANDRESEN
FUNDRAISING CHAIR
PO BOX 124
MONTEVIDEO MN 56265

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/1/2009
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N61 - Fishing, Hunting Clubs
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 No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
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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