FORM 1023-EZ for LAKE COUNTY CONTRACTORS SAFETY FUND

Field Data
EIN 31-1798691
Case Number EO-2016057-000145
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE COUNTY CONTRACTORS SAFETY FUND
Organization’s Mailing Address 1850 W WINCHESTER ROAD UNIT 111
City LIBERTYVILLE
State IL
ZIP 60048
Accounting period End 12
Primary contact name TIM MARABELLA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TIM MARABELLA
BOARD OF DIRECTOR
1850 W WINCHESTER ROAD UNIT 111
LIBERTYVILLE IL 60048

Officer/Director/Trustee Two

FRED RODHEIM
BOARD OF DIRECTOR
1401 SHERIDIAN ROAD
NORTH CHICAGO IL 60064

Officer/Director/Trustee Three

HUGH MCCANN
BOARD OF DIRECTOR
1512 ARTAIUS PARKWAY SUITE 100
LIBERTYVILLE IL 60048

Organization’s website NA
Organization’s email TMARABELLA@LCCA-IL.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/27/1999
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M40 - Safety Education
Organization’s purpose Charitable: No
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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