FORM 1023-EZ for MEDINA HOCKEY CLUB

Field Data
EIN 82-4458272
Case Number EO-2018067-000108
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MEDINA HOCKEY CLUB
Organization’s Mailing Address 17817 SHAW AVENUE
City LAKEWOOD
State OH
ZIP 44107-1013
Accounting period End 12
Primary contact name RANDY HRABAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

COREY HICAR
TRUSTEE
16486 S RED ROCK DRIVE
STRONGSVILLE OH 44136-7336

Officer/Director/Trustee Two

RANDY HRABAK
REGISTERED AGENT
17817 SHAW AVE
LAKEWOOD OH 44107-1013

Organization’s website WWW.MEDINAHOCKEY.COM
Organization’s email MEDINAHOCKEY@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/19/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 COREY HICAR
Signature Title TRUSTEE
Signature Date 3/6/18

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