FORM 1023-EZ for FIDELITY LODGE NO 51 CHARITABLE FOUNDATION

Field Data
EIN 83-2543350
Case Number EO-2019316-000174
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FIDELITY LODGE NO 51 CHARITABLE FOUNDATION
Organization’s Mailing Address 1414 NORTH 9TH
City DAVID CITY
State NE
ZIP 68632
Accounting period End 12
Primary contact name REGINALD S KUHN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KENT CLYMER
PRESIDENT/DIRECTOR
3170 L ROAD
DAVID CITY NE 68632

Officer/Director/Trustee Two

LARRY GRIFFITHS
SECRETARY/DIRECTOR
1414 N 9TH STREET
DAVID CITY NE 68632

Officer/Director/Trustee Three

DALE COOPER
TREASURER
1055 N 11TH STREET
DAVID CITY NE 68632

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/6/18
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 No
Correctness Declaration Yes
Signature Name LARRY GRIFFITHS
Signature Title SECRETARY/DIRECTOR
Signature Date 11/7/19

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