FORM 1023-EZ for PIEDMONT COMMUNITY LACROSSE ASSOCIATION

Field Data
EIN 46-4607291
Case Number EO-2020015-000281
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PIEDMONT COMMUNITY LACROSSE ASSOCIATION
Organization’s Mailing Address 1959 N PEACE HAVEN RD NO322
City WINSTON SALEM
State NC
ZIP 27106-4850
Accounting period End 12
Primary contact name PATRICK BRUNING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN GILMAN
EXECUTIVE DIRECTOR
5506 GATE POST COURT
GREENSVORO NC 27455

Officer/Director/Trustee Two

JOEL ZENDEL
DIRECTOR GIRLS LACROSSE
2453 FIDDLERS GLENN DR
WINSTON SALEM NC 27127

Officer/Director/Trustee Three

PATRICK BRUNING
TREASURER
6525 PINE HALL RD
BELEWS CREEK NC 27009

Organization’s website WWW.PIEDMONTNCLAX.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2013
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
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 PATRICK BRUNING
Signature Title TREASURER
Signature Date 1/13/2020

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