FORM 1023-EZ for CALEBS CLUBHOUSE

Field Data
EIN 81-3297732
Case Number EO-2016285-000270
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CALEBS CLUBHOUSE
Organization’s Mailing Address 5300 36TH ST SW
City MINOT
State ND
ZIP 58701-2718
Accounting period End 12
Primary contact name SHANNON SCHMIDT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHANNON SCHMIDT
CHIEF OPERATING OFFICER
5300 36TH ST SW
MINOT ND 58701-2718

Officer/Director/Trustee Two

JULIA KOBLE
MEMBER
524 27TH ST NW
MINOT ND 58703-1885

Officer/Director/Trustee Three

KELSEY BRAUNBERGER
DIRECTOR
1020 70TH ST S
MINOT ND 58701-9324

Officer/Director/Trustee Four

KYLEE GEER
MEMBER
315 MAIN ST S STE 104
MINOT ND 58701-3956

Officer/Director/Trustee Five

KRYSTAL BUTGEREIT
MEMBER
101 3RD AVE SW
MINOT ND 58701-3880

Organization’s website
Organization’s email CCHMINOT@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/18/2016
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G84 - Autism
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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