FORM 1023-EZ for LAKE BASIN SENIORS INC

Field Data
EIN 85-2495426
Case Number EO-2020273-000920
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKE BASIN SENIORS INC
Organization’s Mailing Address PO BOX 96
City RAPELJE
State MT
ZIP 59067-0096
Accounting period End 12
Primary contact name MICHAEL ERFLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DON HERZOG
PRESIDENT
PO BOX 67
RAPELJE MT 59067-0067

Officer/Director/Trustee Two

BARRY TROYER
SECRETARY TREASURER
48 AUTUMN RD
PARK CITY MT 59063

Officer/Director/Trustee Three

SHAWN ERFLE
VICE PRESIDENT
PO BOX 85
RAPELJE MT 59067-0085

Officer/Director/Trustee Four

GLEN WESTERVELT
DIRECTOR
PO BOX 86
RAPELJE MT 59067-0086

Officer/Director/Trustee Five

MICHAEL ERFLE
DIRECTOR
PO BOX 102
RAPELJE MT 59067-0102

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/11/2020
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P81 - Senior 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 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 MICHAEL ERFLE
Signature Title DIRECTOR
Signature Date 9/26/2020

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