FORM 1023-EZ for MICHIGAN SAFETY CONSORTIUM

Field Data
EIN 37-1636197
Case Number EO-2017135-000275
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MICHIGAN SAFETY CONSORTIUM
Organization’s Mailing Address 490 S LAKESHORE DRIVE
City LUDINGTON
State MI
ZIP 49431
Accounting period End 12
Primary contact name SUZY KOTHS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN KOTHS
PRESIDENT
490 S LAKESHORE DRIVE
LUDINGTON MI 49431

Officer/Director/Trustee Two

RICHARD KOTHS
TREASURER
490 S LAKESHORE DRIVE
LUDINGTON MI 49431

Officer/Director/Trustee Three

MARY SUURMEYER
SECRETARY
465 BEDFORD ROAD
EAST LANSING MI 48823

Officer/Director/Trustee Four

BO FERMAN
DIRECTOR
2713 MONTEGO
LANSING MI 48912

Officer/Director/Trustee Five

WILLIAM CARTER
DIRECTOR
3333 MOORES RIVER DRIVE
LANSING MI 48911

Organization’s website
Organization’s email MISAFETYCONSORTIUM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/5/2011
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M40 - Safety Education
Organization’s purpose Charitable: No
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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