FORM 1023-EZ for SIMLEY BOYS SWIM AND DIVE

Field Data
EIN 84-2102725
Case Number EO-2019177-000223
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SIMLEY BOYS SWIM AND DIVE
Organization’s Mailing Address PO BOX 2102
City INVER GROVE HEIGHTS
State MN
ZIP 55076
Accounting period End 6
Primary contact name DAVID TABOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID TABOR
PRESIDENT
4075 UPPER 61ST PATH E
INVER GROVE HEIGHTS MN 55076

Officer/Director/Trustee Two

LORI ILLETSCHKO
MEMBER AT LARGE
3875 89TH STREET E
INVER GROVE HEIGHTS MN 55076

Officer/Director/Trustee Three

ABBIE LOSINSKI
TREASURE
7168 CORLISS WAY
INVER GROVE HEIGHTS MN 55076

Officer/Director/Trustee Four

MELISSA SCHROEDER
MEMBER AT LARGE
3871 63RD STREET E
INVER GROVE HEIGHTS MN 55076

Officer/Director/Trustee Five

ALLISON MOMPHER
SECRETARY
6521 DAWN AVE
INVER GROVE HEIGHTS MN 55076

Organization’s website
Organization’s email SWIMDIVESIMLEYBOYS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/18/19
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N67 - Swimming, Water Recreation
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 No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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 DAVID TABOR
Signature Title PRESIDENT
Signature Date 6/24/19

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