FORM 1023-EZ for SPLIT ROCK
| Field | Data |
|---|---|
| EIN | 82-3857194 |
| Case Number | EO-2018010-000088 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | SPLIT ROCK |
| Organization’s Mailing Address | 14214 E WILD JESSE WAY |
| City | VAIL |
| State | AZ |
| ZIP | 85641 |
| Accounting period End | 12 |
| Primary contact name | TIMOTHY BHAJJAN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
TIMOTHY BHAJJAN
PRESIDENT, DIRECTOR
1902 S CATHY AVE
TUCSON AZ 85710
Officer/Director/Trustee Two
MARIAN BAKKEN
SECRETARY, DIRECTOR
916 STEARNS ST
CROOKSTON MN 56716
Officer/Director/Trustee Three
BRENDA EDGAR
TREASURER, DIRECTOR
23800 330TH AVE NW
WARREN MN 56762
Officer/Director/Trustee Four
SCOTT EDGAR
DIRECTOR
23800 330TH AVE NW
WARREN MN 56762
Officer/Director/Trustee Five
MARTHA BHAJJAN
DIRECTOR
1902 S CATHY AVE
TUCSON AZ 85710
| Organization’s website | N/A |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/22/17 |
| Organization Incorporation State | AZ |
| 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: Yes 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 | Yes |
| Donation of funds | Yes |
| 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 | 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 | TIMOTHY BHAJJAN |
| Signature Title | PRESIDENT, DIRECTOR |
| Signature Date | 1/8/18 |
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