FORM 1023-EZ for BRAINERD BLUE LINE BOOSTERS

Field Data
EIN 84-1758555
Case Number EO-2019137-000275
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BRAINERD BLUE LINE BOOSTERS
Organization’s Mailing Address 13230 TIMBERLANE DR
City BAXTER
State MN
ZIP 56425
Accounting period End 12
Primary contact name JENNIFER URBAN - CAF 0308-14263R
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SAMUEL BLUM
PRESIDENT & DIRECTOR
724 W WASHINGTON ST
BRAINERD MN 56401

Officer/Director/Trustee Two

MICHAEL PATRICK
VICE PRESIDENT & DIRECTOR
13230 TIMBERLANE DR
BAXTER MN 56425

Officer/Director/Trustee Three

RICHARD JONES
SEC/TREAS & DIRECTOR
724 W WASHINGTON ST
BRAINERD MN 56401

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/19
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N68 - Winter Sports (Snow and Ice)
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 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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHAEL PATRICK
Signature Title VICE PRESIDENT & DIRECTOR
Signature Date 5/15/19

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