FORM 1023-EZ for LACROSSE CLUB OF MID COAST FLORIDAINC

Field Data
EIN 83-4026445
Case Number EO-2019087-000328
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LACROSSE CLUB OF MID COAST FLORIDAINC
Organization’s Mailing Address 3635 MANASSAS AVE
City MELBOURNE
State FL
ZIP 32934
Accounting period End 12
Primary contact name DANIEL HENSLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIEL HENSLER
DIRECTOR
3635 MANASSAS AVENUE
MELBOURNE FL 32934

Officer/Director/Trustee Two

SASHA HENSLER
DIRECTOR
3635 MANASSAS AVENUE
MELBOURNE FL 32934

Officer/Director/Trustee Three

CLAUDIA BOLOGNINI
DIRECTOR
4475 CAROLWOOD DRIVE
MELBOURNE FL 32934

Officer/Director/Trustee Four

RICHARD BOLOGNINI
DIRECTOR
4475 MANASSAS AVE
MELBOURNE FL 32934

Organization’s website
Organization’s email RENEGADES.LACROSSE@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/11/19
Organization Incorporation State FL
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: 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 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 DANIEL HENSLER
Signature Title DIRECTOR
Signature Date 3/26/19
EIN 83-4026445
Case Number EO-2019087-000328
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LACROSSE CLUB OF MID COAST FLORIDA INC
Organization’s Mailing Address 3635 MANASSAS AVE
City MELBOURNE
State FL
ZIP 32934
Accounting period End 12
Primary contact name DANIEL HENSLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIEL HENSLER
DIRECTOR
3635 MANASSAS AVENUE
MELBOURNE FL 32934

Officer/Director/Trustee Two

SASHA HENSLER
DIRECTOR
3635 MANASSAS AVENUE
MELBOURNE FL 32934

Officer/Director/Trustee Three

CLAUDIA BOLOGNINI
DIRECTOR
4475 CAROLWOOD DRIVE
MELBOURNE FL 32934

Officer/Director/Trustee Four

RICHARD BOLOGNINI
DIRECTOR
4475 MANASSAS AVE
MELBOURNE FL 32934

Organization’s website
Organization’s email RENEGADES.LACROSSE@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/11/19
Organization Incorporation State FL
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: 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 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 DANIEL HENSLER
Signature Title DIRECTOR
Signature Date 3/26/19

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