FORM 1023-EZ for WORKERS SERIOUS INJURY AND FATALITYFUND
| Field | Data |
|---|---|
| EIN | 84-5165098 |
| Case Number | EO-2020122-000311 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | WORKERS SERIOUS INJURY AND FATALITYFUND |
| Organization’s Mailing Address | 629 OKLAHOMA DR |
| City | THREE RIVERS |
| State | MI |
| ZIP | 49093 |
| Accounting period End | 6 |
| Primary contact name | JUSTIN FREESE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JUSTIN FREESE
PRESIDENT AND DIRECTOR
629 OKLAHOMA DR
THREE RIVERS MI 49093
Officer/Director/Trustee Two
BRANDON LOVE
SECRETARY AND DIRECTOR
12743 VALLEY DR
WAYLAND MI 49348
Officer/Director/Trustee Three
ANDREW FRISBIE
TRASURER AND DIRECTOR
53719 CLARK ST
MATTAWAN MI 49071
Officer/Director/Trustee Four
THOMAS KONECSNI
DIRECTOR
2561 WINDING RIDGE TRL NE
ROCKFORD MI 49341
Officer/Director/Trustee Five
ROBERT MONTEL
DIRECTOR
19473 MUD LAKE ST
CASSOPOLIS MI 49031
| Organization’s website | NONE |
|---|---|
| Organization’s email | JFREESE10@OUTLOOK.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 2/14/2020 |
| Organization Incorporation State | MI |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | B82 - Scholarships, Student Financial Aid Services, Awards |
| 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 | Yes |
| 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 | JUSTIN FREESE |
| Signature Title | PRESIDENT AND DIRECTOR |
| Signature Date | 4/29/2020 |
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