FORM 1023-EZ for PEMBINA COUNTY BACKPACK PROGRAM INC

Field Data
EIN 85-1780963
Case Number EO-2020209-000196
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PEMBINA COUNTY BACKPACK PROGRAM INC
Organization’s Mailing Address PO BOX 73
City DRAYTON
State ND
ZIP 58225
Accounting period End 12
Primary contact name R SCOTT STEWART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORI CANTELE
PRESIDENT
10497
WALHALLA ND 58225

Officer/Director/Trustee Two

TINA BREVIK
SECRETARY
PO BOX 531
CAVALIER ND 58220

Officer/Director/Trustee Three

SHERI KUZNIA
TREASURER
604 WINDOM STREET
DRAYTON ND 58225

Organization’s website
Organization’s email PCGOBACKPACK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/30/2020
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 LORI CANTELE
Signature Title PRESIDENT
Signature Date 7/17/2020

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