FORM 1023-EZ for CLARK COUNTY FIREMEN ASSOCIATION INC

Field Data
EIN 87-1471030
Case Number EO-2021203-000333
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLARK COUNTY FIREMEN ASSOCIATION INC
Organization’s Mailing Address 16433 432ND AVENUE
City GARDEN CITY
State SD
ZIP 58236-5114
Accounting period End 12
Primary contact name JAY FOSTER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAY FOSTER
PRESIDENT DIRECTOR
16433 432ND AVENUE
GARDEN CITY SD 57236-5114

Officer/Director/Trustee Two

SHANE HAGSTROM
VICE PRESIDENT DIRECTOR
306 NORTH SMITH STREET
CLAKR SD 57225-1427

Officer/Director/Trustee Three

GARRETT SEEFELDT
SECRETARY DIRECTOR
404 GRANT AVENUE
WILLOW LAKE SD 57278-2312

Officer/Director/Trustee Four

LANE WIRTJES
TREASURER DIRECTOR
PO BOX 52
WILLOW LAKE SD 57278-0052

Officer/Director/Trustee Five

THOMAS BURNS
DIRECTOR
820 N BROADWAY
WATERTOWN SD 57201

Organization’s website
Organization’s email TOMBURNS@IW.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/28/2021
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M12 - Fund Raising and/or Fund Distribution
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JAY FOSTER
Signature Title PRESIDENT DIRECTOR
Signature Date 7/20/2021

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