FORM 1023-EZ for AVHS GLAX BOOSTER CLUB

Field Data
EIN 81-5328694
Case Number EO-2017229-000301
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AVHS GLAX BOOSTER CLUB
Organization’s Mailing Address APPLE VALLEY HS 14450 HAYES ROAD
City APPLE VALLEY
State MN
ZIP 55124-6797
Accounting period End 6
Primary contact name KIMBERLY SEGAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAN MOYNIHAN
PRESIDENT
1726 FORSSA WAY
EAGAN MN 55122-2658

Officer/Director/Trustee Two

KIMBERLY SEGAR
TREASURER
1317 FOREST PARK LANE
BURNSVILLE MN 55337-4779

Officer/Director/Trustee Three

BRIAN MOYNIHAN
ADMINISTRATIVE ASSISTANT
1726 FORSSA WAY
EAGAN MN 55122-2658

Officer/Director/Trustee Four

TOM KUCHERA
VICE PRESIDENT
16323 GRINNELL CIRCLE
LAKEVILLE MN 55044-6109

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/9/2017
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: Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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