FORM 1023-EZ for USC ATHLETIC BOOSTER CLUB

Field Data
EIN 41-1851389
Case Number EO-2016070-000233
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name USC ATHLETIC BOOSTER CLUB
Organization’s Mailing Address 600 11TH STREET SW
City WELLS
State MN
ZIP 56097
Accounting period End 12
Primary contact name BEAU A HARTMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHAD KLOCEK
PRESIDENT
600 11TH STREET SW
WELLS MN 56097

Officer/Director/Trustee Two

DOUG BECHER
VICE PRESIDENT
600 11TH STREET SW
WELLS MN 56097

Officer/Director/Trustee Three

MARK HERMAN
SECRETARY
600 11TH STREET SW
WELLS MN 56097

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/6/2015
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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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