FORM 1023-EZ for ROSLYN LUTHERAN FOUNDATION

Field Data
EIN 47-3479733
Case Number EO-2017100-000413
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROSLYN LUTHERAN FOUNDATION
Organization’s Mailing Address 43216 129TH STREET
City ROSLYN
State SD
ZIP 57261
Accounting period End 12
Primary contact name KERRI WAGNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THERON WAGNER
PRESIDENT/TRUSTEE
43428 129TH STREET
ROSLYN SD 57261

Officer/Director/Trustee Two

JOSH WAGNER
VICE PRESIDENT/TRUSTEE
43347 129TH STREET
ROSLYN SD 57261

Officer/Director/Trustee Three

KERRI WAGNER
SECRETARY/TREASURER
43416 129TH STREET
ROSLYN SD 57261

Officer/Director/Trustee Four

GEORGE BLANK
TRUSTEE
16127 35TH STREET SE
CASSELTON ND 58012

Officer/Director/Trustee Five

MARK HANSON
TRUSTEE
44233 129TH STREET
GRENVILLE SD 57239

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/2015
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X21 - Protestant
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 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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