FORM 1023-EZ for MAPLE GROVE LIONS FOUNDATION

Field Data
EIN 84-1834750
Case Number EO-2019143-000410
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MAPLE GROVE LIONS FOUNDATION
Organization’s Mailing Address 860 BLUE GENTIAN ROAD SUITE 190
City EAGAN
State MN
ZIP 55121
Accounting period End 12
Primary contact name RONALD J WALSH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RONALD WALSH
CHAIRMAN-CEO
7383 WEST FISH LAKE ROAD
MAPLE GROVE MN 55311

Officer/Director/Trustee Two

STEVEN KELLY
VICE CHAIRMAN-OFFICER
9107 NORWOOD LANE N
MAPLE GROVE MN 55369

Officer/Director/Trustee Three

JAN CARIVEAU
SECRETARY-OFFICER
9351 TRENTON LANE
MAPLE GROVE MN 55369

Officer/Director/Trustee Four

VICKIE PARKS
TREASURER-OFFICER
7343 NIAGARA LANE NORTH
MAPLE GROVE MN 55311

Officer/Director/Trustee Five

RICHARD KENTZELMAN
OFFICER
9928-95TH AVENUE NORTH
MAPLE GROVE MN 55369

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/14/19
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P86 - Blind/Visually Impaired Centers, Services
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 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 RONALD WALSH
Signature Title CHAIRMAN-CEO
Signature Date 5/21/19

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