FORM 1023-EZ for LANE LOGAN MEMORIAL

Field Data
EIN 81-4566550
Case Number EO-2018262-000272
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LANE LOGAN MEMORIAL
Organization’s Mailing Address 2424 SERENITY DRIVE
City WATERTOWN
State SD
ZIP 57201
Accounting period End 12
Primary contact name ZACK WIPF
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ZACK WIPF
PRESIDENT
2424 SERENITY DR
WATERTOWN SD 57201

Officer/Director/Trustee Two

HEATHER WIPF
TREASURER
2424 SERENITY DR
WATERTOWN SD 57201

Officer/Director/Trustee Three

JAMIE JORDAN
VICE PRESIDENT
916 N BROADWAY
WATERTOWN SD 57201

Officer/Director/Trustee Four

LASHAWN FARTHING
SECRETARY
408 5TH ST SE
WATERTOWN SD 57201

Officer/Director/Trustee Five

ROBB KLEEN
OFFICER
17537 460TH AVE
WATERTOWN SD 57201

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/16/16
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F70 - Mental Health Disorders
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ZACK WIPF
Signature Title PRESIDENT
Signature Date 9/17/18

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