FORM 1023-EZ for CLAM FALLS FLOWAGE LAKE ASSOCIATIONINCORPORATIONED

Field Data
EIN 84-3150370
Case Number EO-2019333-000016
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLAM FALLS FLOWAGE LAKE ASSOCIATIONINCORPORATIONED
Organization’s Mailing Address 3393 BOONE ROAD
City FREDERIC
State WI
ZIP 54837
Accounting period End 6
Primary contact name DONALD WORTHAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTIAN DONOVAN
PRESIDENT
19760 JAVA PATH
LAKEVILLE MN 55044

Officer/Director/Trustee Two

JACKLYN MOODY
VICE PRESIDENT
628 335TH AVENUE
FREDERIC WI 54837

Officer/Director/Trustee Three

DONALD WORTHAM
TREASURER
3393 BOONE ROAD
FREDERIC WI 54837

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/12/2019
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C01 - Alliance/Advocacy Organizations
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 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 DONALD WORTHAM
Signature Title TREASURER
Signature Date 11/25/2019

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