FORM 1023-EZ for MINNESOTA JCI SENATE FOUNDATION

Field Data
EIN 82-0968349
Case Number EO-2017102-000149
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MINNESOTA JCI SENATE FOUNDATION
Organization’s Mailing Address 1405 LILAC DR N STE 125
City GOLDEN VALLEY
State MN
ZIP 55422-4549
Accounting period End 6
Primary contact name MARK A EWERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARK EWERT
PRESIDENT, DIRECTOR
1619 CHADUM LANE
SHAKOPEE MN 55379

Officer/Director/Trustee Two

KETTIE GREEN
SECRETARY, DIRECTOR
4722 BLANDING COURT
BIG LAKE MN 55309

Officer/Director/Trustee Three

GREG BORDERS
TREASURER, DIRECTOR
525 1ST AVENUE NORTH APT 5
FARGO ND 58102

Officer/Director/Trustee Four

DOREEN LIETZAU
1ST VICE-PRESIDENT, DIRECTOR
5300 WEST 210TH STREET
FARIBAULT MN 55021

Officer/Director/Trustee Five

RANDY YOUNG
2ND VICE-PRESIDENT, DIRECTOR
2367 BUSE AVENUE EAST
MAPLEWOOD MN 55119

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/21/2017
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T40 - Voluntarism Promotion
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
Signature Title
Signature Date

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