FORM 1023-EZ for EHS SWIM AND DIVE BOOSTER CLUB

Field Data
EIN 20-1349419
Case Number EO-2014223-000090
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EHS SWIM AND DIVE BOOSTER CLUB
Organization’s Mailing Address 4185 BRADDOCK TRAIL
City EAGAN
State MN
ZIP 55123-1575
Accounting period End 4
Primary contact name DARCI DAWSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GUS BROMAN
CO-PRESIDENT
567 CAYLIN CT
EAGAN MN 55123-3100

Officer/Director/Trustee Two

ELAINE STEVENS
CO-PRESIDENT
4387 HAMILTON DR
EAGAN MN 55123-2603

Officer/Director/Trustee Three

DARCI DAWSON
CO-TREASURER
515 BROOKLYN CT
EAGAN MN 55123-4501

Officer/Director/Trustee Four

THERESA JURISCH
CO-TREASURER
3561 WIDGEON WAY
EAGAN MN 55123-1004

Officer/Director/Trustee Five

SHARI VOSS
SECRETARY
690 HANOVER CT
EAGAN MN 55123-1668

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/26/2004
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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