FORM 1023-EZ for LA GRANDE MAT CLUB

Field Data
EIN 45-3850228
Case Number EO-2015268-000145
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LA GRANDE MAT CLUB
Organization’s Mailing Address 61523 BLACKHAWK TRAIL LN
City LA GRANDE
State OR
ZIP 97850
Accounting period End 6
Primary contact name SCOTT BISENIUS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JASON KEHR
PRESIDENT
2008 3RD ST SUITE B
LA GRANDE OR 97850

Officer/Director/Trustee Two

GEOFF ROBINSON
VISE - PRESIDENT
208 AQUARIUS WAY
LA GRANDE OR 97850

Officer/Director/Trustee Three

KATHLEEN MCCALL
SECRITARY
1507 X AVE
LA GRANDE OR 97850

Officer/Director/Trustee Four

SCOTT BISENIUS
TREASURER
61523 BLACKHAWK TRAIL LN
LAGRANDE OR 97850

Officer/Director/Trustee Five

KATHY SHAW
FUNDRAISING CORDINATOR
810 LAKE AVE
LAGRANDE OR 97850

Organization’s website LAGRANDEMATCLUB.COM
Organization’s email SBISENIUS@LAGRANDECPA.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2011
Organization Incorporation State OR
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 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
Signature Title
Signature Date

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