FORM 1023-EZ for ORPHAN CARE INTERNATIONAL

Field Data
EIN 81-3217903
Case Number EO-2016204-000038
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ORPHAN CARE INTERNATIONAL
Organization’s Mailing Address 3593 BIRCHPOND ROAD
City EAGAN
State MN
ZIP 55122
Accounting period End 12
Primary contact name JACQUELINE STANLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICK WALKER
PRESIDENT
3593 BIRCHPOND ROAD
EAGAN MN 55122

Officer/Director/Trustee Two

MATTHEW JENSEN
VICE PRESIDENT
1586 STEPHANIE CIRCLE
EAGAN MN 55121

Officer/Director/Trustee Three

BENJAMIN LORENCE
TREASURER
12820 GARRETT COURT
APPLE VALLEY MN 55124

Officer/Director/Trustee Four

DAVID SPANDE
SECRETARY
4824 E 53RD STREET 505
MINNEAPOLIS MN 55417

Officer/Director/Trustee Five

MARY WALKER
BOARD MEMBER
3593 BIRCHPOND ROAD
EAGAN MN 55122

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/31/2016
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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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