FORM 1023-EZ for FOUNTAIN LAKE SPORTSMENS CLUB INC

Field Data
EIN 41-1416101
Case Number EO-2018169-000579
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOUNTAIN LAKE SPORTSMENS CLUB INC
Organization’s Mailing Address PO BOX 524
City ALBERT LEA
State MN
ZIP 56007
Accounting period End 12
Primary contact name KAVIN DRESSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LARRY PENCE
PRESIDENT
404 CHANNEL RD
ALBERT LEA MN 56007

Officer/Director/Trustee Two

CHRIS SEEDORF
VICE PRESIDENT
302 HILLCREST CIRCLE
CLARKS GROVE MN 56016

Officer/Director/Trustee Three

JEAN MILLER
SECRETARY
363 HILLCREST CIRCLE
CLARKS GROVE MN 56016

Officer/Director/Trustee Four

LARRY STEINHAUER
TREASURER
11289 560TH AVE
WELLS MN 56097

Officer/Director/Trustee Five

KAVIN DRESSEN
BOARD MEMBER
1605 CRYSTAL DR
ALBERT LEA MN 56007

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/20/85
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N61 - Fishing, Hunting Clubs
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 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 Yes
Correctness Declaration Yes
Signature Name KAVIN DRESSEN
Signature Title BOARD MEMBER
Signature Date 6/14/18

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