FORM 1023-EZ for PALMYRA LADY COUGAR BASKETBALL BOOSTER CLUB

Field Data
EIN 46-1390996
Case Number EO-2016251-000081
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PALMYRA LADY COUGAR BASKETBALL BOOSTER CLUB
Organization’s Mailing Address 432 FARMHOUSE LANE
City PALMYRA
State PA
ZIP 17078
Accounting period End 12
Primary contact name HEATHER RICHARDSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SCOTT WERKHEISER
PRESIDENT
125 PICKWICK CIRCLE
PALMYRA PA 17078

Officer/Director/Trustee Two

KRISTY WERKHEISER
VICE PRESIDENT
125 PICKWICK CIRCLE
PALMYRA PA 17078

Officer/Director/Trustee Three

KIMBERLY MCLUCAS
TREASURER
439 ORCHARD HILL DRIVE
PALMYRA PA 17078

Officer/Director/Trustee Four

LYNNE SHUEY
SECRETARY
813 GRAVEL HILL RD
PALMYRA PA 17078

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/2012
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
Organization’s purpose Charitable: Yes
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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