FORM 1023-EZ for GREAT LAKES WATER SAFETY CONSORTIUM

Field Data
EIN 81-2812105
Case Number EO-2016187-000098
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GREAT LAKES WATER SAFETY CONSORTIUM
Organization’s Mailing Address 11802 LOUIS LN
City WHITMORE LAKE
State MI
ZIP 48189
Accounting period End 12
Primary contact name JAMES RACKLYEFT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JAMES RACKLYEFT
PRESIDENT, DIRECTOR
11802 LOUIS LN
WHITMORE LAKE MI 48189

Officer/Director/Trustee Two

MEGAN DODSON
SECRETARY, DIRECTOR
183 CHERRY ST
WARSAW IN 46582

Officer/Director/Trustee Three

RULA KARAPATSAKIS
TREASURER, DIRECTOR
1004 HOLBROOKE DR
CANTON MI 48187

Officer/Director/Trustee Four

BOB DUKESHERER
DIRECTOR
5258 VIRGINIA LN
GRANDVILLE MI 49418

Officer/Director/Trustee Five

GENE CLARK
DIRECTOR
4222 CARIBOU LAKE RD
DULUTH MN 55810

Organization’s website WWW.GREATLAKESWATERSAFETY.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/23/2016
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 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
Signature Title
Signature Date

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