FORM 1023-EZ for DMBGC FOUNDATION

Field Data
EIN 81-0847965
Case Number EO-2016123-000296
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DMBGC FOUNDATION
Organization’s Mailing Address 201 E PARK ST
City CHAMPAIGN
State IL
ZIP 61820
Accounting period End 12
Primary contact name RAY PRATT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TODD PETERSEN
PRESIDENT
3010 WYNSTONE DR
CHAMPAIGN IL 61822

Officer/Director/Trustee Two

MICHAEL COMET
SEC/TREAS
805 DODDS DR
CHAMPAIGN IL 61821

Officer/Director/Trustee Three

TONEY TOMASO
DIRECTOR
4704 WESTBOROUGH DR
CHAMPAIGN IL 61822

Officer/Director/Trustee Four

MARK HOLM
DIRECTOR
702 S JAMES ST
CHAMPAIGN IL 61821

Officer/Director/Trustee Five

MARK RITZ
DIRECTOR
906 W CHARLES ST
CHAMPAIGN IL 61821

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
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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