FORM 1023-EZ for BLOOMINGTON LACROSSE INC

Field Data
EIN 47-5135800
Case Number EO-2016309-000163
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLOOMINGTON LACROSSE INC
Organization’s Mailing Address PO BOX 604
City CLEAR CREEK
State IN
ZIP 47426-0604
Accounting period End 6
Primary contact name LISA BELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LISA BELL
PRESIDENT
7843 S ZIKES ROAD
BLOOMINGTON IN 47401-9177

Officer/Director/Trustee Two

ALI PIOVESAN
VICE PRESIDENT
3755 N COLLINS DRIVE
BLOOMINGTON IN 47404-9594

Officer/Director/Trustee Three

TOM KAY
TREASURER
8287 S MCKENZIE COURT
BLOOMINGTON IN 47401-9495

Officer/Director/Trustee Four

KRISTI JACKSON
SECRETARY
502 S COBBLESTONE COURT
BLOOMINGTON IN 47403-8954

Officer/Director/Trustee Five

BARRE KLAPPER
BLMGTN HS SOUTH CO MANAGER
1112 E 1ST STREET
BLOOMINGTON IN 47401-5006

Organization’s website WWW.BLOOMINGTONLAX.COM
Organization’s email BLOOMINGTONLAX@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/18/2016
Organization Incorporation State IN
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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