FORM 1023-EZ for JEFFERSON GIRLS TRAVELING BASKETBALL ASSOCIATION

Field Data
EIN 41-1700018
Case Number EO-2021172-000195
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JEFFERSON GIRLS TRAVELING BASKETBALL ASSOCIATION
Organization’s Mailing Address PO BOX 385225
City BLOOMINGTON
State MN
ZIP 55438-5225
Accounting period End 4
Primary contact name TERI BOKUSKY - TREASURER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAN DROLLINGER
PRESIDENT
PO BOX 385225
BLOOMINGTON MN 55438-5225

Officer/Director/Trustee Two

TERI BOKUSKY
TREASURER
PO BOX 385225
BLOOMINGTON MN 55438-5225

Officer/Director/Trustee Three

DAYNA BASSETT
SECRETARY
PO BOX 385225
BLOOMINGTON MN 55438-5225

Officer/Director/Trustee Four

KEVIN LEYK
RISK MANAGEMENT
PO BOX 385225
BLOOMINGTON MN 55438-5225

Officer/Director/Trustee Five

RYAN CATALANO
TOURNAMENT DIRECTOR
PO BOX 385225
BLOOMINGTON MN 55438-5225

Organization’s website JEFFERSONGBB.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/27/2009
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N62 - Basketball
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TERI BOKUSKY
Signature Title TREASURER
Signature Date 6/16/2021

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