FORM 1023-EZ for RACCA CANCER FOUNDATION

Field Data
EIN 30-0997083
Case Number EO-2019192-000249
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RACCA CANCER FOUNDATION
Organization’s Mailing Address 6001 4TH STREET NE
City FRIDLEY
State MN
ZIP 55432
Accounting period End 12
Primary contact name TANIA HOLCOMB
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRANDON MELIN
PRESIDENT & TREASURER
6001 4TH STREET NE
FRIDLEY MN 55432

Officer/Director/Trustee Two

ROB ROSENER
VICE PRESIDENT
10970 COTTONWOOD STREET NW
COON RAPIDS MN 55448

Officer/Director/Trustee Three

ANDREW KINARD
SECRETARY
11356 PALM STREET NW
COON RAPIDS MN 55448

Officer/Director/Trustee Four

RAYMOND JORDAN
MEMBER AT LARGE
1901 KLONDIKE BLVD
EAST BETHEL MN 55011

Officer/Director/Trustee Five

JOSH RADLE
MEMBER AT LARGE
7635 165TH STREET W
LAKEVILLE MN 55044

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/11/17
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
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 Yes
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 BRANDON MELIN
Signature Title PRESIDENT & TREASURER
Signature Date 7/9/19

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