FORM 1023-EZ for CAMEL CITY TRACK FOUNDATION

Field Data
EIN 47-5394886
Case Number EO-2015313-000170
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAMEL CITY TRACK FOUNDATION
Organization’s Mailing Address 301 NORTH MAIN STREET SUITE 2300
City WINSTON-SALEM
State NC
ZIP 27101-3885
Accounting period End 12
Primary contact name KRISTAN D BRYANT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CRAIG LONGHURST
PRESIDENT; DIRECTOR
301 NORTH MAIN STREET SUITE 2300
WINSTON-SALEM NC 27101-3885

Officer/Director/Trustee Two

VERONICA RODRIGUEZ
TREASURER; DIRECTOR
301 NORTH MAIN STREET SUITE 2300
WINSTON-SALEM NC 27101-3885

Officer/Director/Trustee Three

JOHN ANDERSON
VICE PRESIDENT; DIRECTOR
2700 WELLSPRINGS DRIVE
PFAFFTOWN NC 27040-9415

Officer/Director/Trustee Four

ROBYN HOLLAND
SECRETARY; DIRECTOR
301 NORTH MAIN STREET SUITE 2300
WINSTON-SALEM NC 27101-3885

Officer/Director/Trustee Five

JEFF ICKES
DIRECTOR
1519 MARTIN LUTHER KING JR DRIVE
WINSTON-SALEM NC 27107-1308

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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