FORM 1023-EZ for LAKE MASSASECUM IMPROVEMENT ASSOCIATION

Field Data
EIN 86-3970027
Case Number EO-2021148-000153
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKE MASSASECUM IMPROVEMENT ASSOCIATION
Organization’s Mailing Address PO BOX 15
City BRADFORD
State NH
ZIP 03221
Accounting period End 12
Primary contact name MICHAEL R DAVIDSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL DAVIDSON
PRESIDENT
82 3RD AVE 1
KINGSTON PA 18704

Officer/Director/Trustee Two

KAREN PRIME
TREASURER
24660 WOOLLY MAMMOTH TERRACE 302
ALDIE VA 20105

Officer/Director/Trustee Three

BEN AINSLIE
VICE PRESIDENT
3 WHITTEMORE ST
HILLSBORO NH 03244

Officer/Director/Trustee Four

MADISON COOK
SECRETARY
62 DAVIS ROAD
BRADFOR NH 03221

Officer/Director/Trustee Five

CINDY NUNNALLY
BOARD MEMBER
2 BACON RD
BRADFORD NH 03221

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/1963
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C32 - Water Resource, Wetlands Conservation and Management
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: Yes
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 MICHAEL DAVIDSON
Signature Title PRESIDENT
Signature Date 5/20/2021

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