FORM 1023-EZ for LAKE OF THE WOODS ADAPTIVE WATERSPORTS

Field Data
EIN 81-1320299
Case Number EO-2016039-000070
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE OF THE WOODS ADAPTIVE WATERSPORTS
Organization’s Mailing Address PO BOX 843
City LOCUST GROVE
State VA
ZIP 22508
Accounting period End 12
Primary contact name JORDY DE BOER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JORDY DE BOER
PRESIDENT
104 FLAT RUN
LOCUST GROVE VA 22508

Officer/Director/Trustee Two

THOMAS PRINE
VICE PRESIDENT
337 STRATFORD CIRCLE
LOCUST GROVE VA 22508

Officer/Director/Trustee Three

SHANE QUINLAN
TREASURES/SECRATARY
2405 LAKEVIEW PARKWAY
LOCUST GROVE VA 22508

Organization’s website
Organization’s email ADAPTIVEWATERSPORTS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/3/2016
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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
Signature Title
Signature Date

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