FORM 1023-EZ for LYNCHBURG HOME SCHOOL ATHLETIC ASSOCIATION

Field Data
EIN 20-5908873
Case Number EO-2017086-000446
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LYNCHBURG HOME SCHOOL ATHLETIC ASSOCIATION
Organization’s Mailing Address 76 RUNNER STONE DRIVE
City EVINGTON
State VA
ZIP 24550
Accounting period End 6
Primary contact name BRYAN JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICK MAGEE
PRESIDENT
124 WOODRIDGE DR
RUSTBURG VA 24588

Officer/Director/Trustee Two

TODD ASSELBORN
DIRECTOR
128 CRESTVIEW DR
RUSTBURG VA 24588

Officer/Director/Trustee Three

PAUL CROWE
DIRECTOR
76 RUNNER STONE DR
EVINGTON VA 24550

Officer/Director/Trustee Four

BRYAN JOHNSON
DIRECTOR
1094 SOMERS WAY
FOREST VA 24551

Officer/Director/Trustee Five

DARRYL GORDON
DIRECTOR
440 CASALOMA DR
FOREST VA 24551

Organization’s website HTTP://LYNCHBURGPATRIOTS.ASSN.LA/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/25/2014
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: Yes
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date
EIN 20-5908873
Case Number EO-2015163-000491
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LYNCHBURG HOMESCHOOL ATHLETIC ASSOCIATION
Organization’s Mailing Address 76 RUNNER STONE DRIVE
City EVINGTON
State VA
ZIP 24550
Accounting period End 6
Primary contact name DANIEL P MOOK ATTORNEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RICK MAGEE
PRESIDENT/CHAIRPERSON
124 WOODRIDGE DRIVE
RUSTBURG VA 24588

Officer/Director/Trustee Two

DARRYL GORDON
TREASURER
440 CASALOMA DRIVE
FOREST VA 24551

Officer/Director/Trustee Three

TODD ASSELBORN
VOTING MEMBER
128 CRESTVIEW DRIVE
RUSTBURG VA 24588

Officer/Director/Trustee Four

KYLE GOLDSMITH
VOTING MEMBER
6313 BEDFORD HWY
LYNCH STATION VA 24571

Officer/Director/Trustee Five

SAM SMITH
VOTING MEMBER
1183 MACON LOOP
LYNCHBURG VA 24503

Organization’s website HTTP://LYNCHBURGPATRIOTS.ASSN.LA/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/25/2014
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: Yes
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 Yes
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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