FORM 1023-EZ for BLUE RIVER LOSS TEAM
| Field | Data |
|---|---|
| EIN | 84-2813423 |
| Case Number | EO-2019238-000388 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | BLUE RIVER LOSS TEAM |
| Organization’s Mailing Address | 1321 COUNTRY CLUB LN |
| City | BEATRICE |
| State | NE |
| ZIP | 68310 |
| Accounting period End | 12 |
| Primary contact name | LAURA KOCH |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JILL KUZELKA
ADVISORY COUNCIL CHAIRPERSON
995 E HWY 33 SUITE 1
CRETE NE 68333
Officer/Director/Trustee Two
SAMANTHA THOMPSON
ADVISORY COUNCIL SECRETARY
505 N 9TH ST
WYMORE NE 68466
Officer/Director/Trustee Three
LAURA KOCH
LOSS TEAM CLINICAL DIRECTOR
1321 COUNTRY CLUB LN
BEATRICE NE 68310
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | No |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/13/18 |
| Organization Incorporation State | NE |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | S01 - Alliance/Advocacy Organizations |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes Scientific: Yes 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 | LAURA KOCH |
| Signature Title | LOSS TEAM CLINICAL DIRECTOR |
| Signature Date | 8/22/19 |
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