FORM 1023-EZ for DEREK SEMANEK MEMORIAL HOCKEY GAME

Field Data
EIN 84-3022995
Case Number EO-2020010-000283
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DEREK SEMANEK MEMORIAL HOCKEY GAME
Organization’s Mailing Address 39 TALL OAKS DRIVE
City HAMBURG
State NJ
ZIP 07419
Accounting period End 12
Primary contact name LAUREN LOWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAUREN LOWELL
REGISTERED AGENT
39 TALL OAKS DRIVE
HAMBURG NJ 07419

Officer/Director/Trustee Two

ALAN SEMANEK
TRUSTEE
433 SHEPPERD LANE
HIGHLAND LAKES NJ 07422

Officer/Director/Trustee Three

LOIS SEMANEK
TRUSTEE
433 SHEPPERD LANE
HIGHLAND LAKES NJ 07422

Officer/Director/Trustee Four

JASON SEMANEK
TRUSTEE
15 SPRING HILL LANE
GREAT MEADOWS NJ 07838

Officer/Director/Trustee Five

LAUREN LOWELL
REGISTERED AGENT
39 TALL OAKS DRIVE
HAMBURG NJ 07419

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/12/2019
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LAUREN LOWELL
Signature Title REGISTERED AGENT
Signature Date 1/8/2020

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