FORM 1023-EZ for KICKS BAND OF FARGO MOORHEAD

Field Data
EIN 82-4603093
Case Number EO-2018075-000072
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KICKS BAND OF FARGO MOORHEAD
Organization’s Mailing Address 2609 4TH AVE SO
City MOORHEAD
State MN
ZIP 56560
Accounting period End 9
Primary contact name TIMOTHY JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SAMUEL WAI
BOARD OF DIRECTORS
1015 10TH AVE SO
MOORHEAD MN 56560

Officer/Director/Trustee Two

J STEPHEN BLAZEK
BOARD OF DIRECTORS
PO BOX 2164
FARGO ND 58107

Officer/Director/Trustee Three

CHRIS GOULD
BOARD OF DIRECTORS
1012 4TH AVE S APT B
FARGO ND 58103

Officer/Director/Trustee Four

TIMOTHY JOHNSON
EXECUTIVE DIRECTOR
2609 4TH AVE SO
MOORHEAD MN 56560

Organization’s website WWW.FMKICKSBAND.COM
Organization’s email FMKICKSBAND@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/14/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A60 - Performing Arts Organizations
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TIMOTHY JOHNSON
Signature Title EXECUTIVE DIRECTOR
Signature Date 3/14/18

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