FORM 1023-EZ for BLAINE SOFTBALL CLUB

Field Data
EIN 81-4738247
Case Number EO-2018109-000276
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLAINE SOFTBALL CLUB
Organization’s Mailing Address 12555 UNIVERSITY AVE NE
City BLAINE
State MN
ZIP 55434
Accounting period End 12
Primary contact name MARY HEINEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY HEINEN
TREASURER
12240 94TH AVE N
MAPLE GROVE MN 55369

Officer/Director/Trustee Two

MARK PEDERSON
PRESIDENT
2962 166TH AVE NE
HAM LAKE MN 55304

Officer/Director/Trustee Three

KEVIN PETERSON
VICE PRESIDENT
1901 140TH LANE NE
HAM LAKE MN 55304

Officer/Director/Trustee Four

SUE HERBERT
SECRETARY
11612 HASTINGS ST NE
BLAINE MN 55449

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/20/16
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
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 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 MARY HEINEN
Signature Title TREASURER
Signature Date 4/15/18

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