FORM 1023-EZ for RICE LAKE YOUTH CYCLING

Field Data
EIN 83-3634803
Case Number EO-2019203-000265
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RICE LAKE YOUTH CYCLING
Organization’s Mailing Address 3000 PIONEER AVE
City RICE LAKE
State WI
ZIP 54868
Accounting period End 12
Primary contact name MATTHEW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MATTHEW NELSON
DIRECTOR
2032 16 1/2 AVE
CAMERON WI 54822

Officer/Director/Trustee Two

JON GARGULAK
TRUSTEE
332 S WISCONSIN AVE
RICE LAKE WI 54868

Officer/Director/Trustee Three

JAMES KIFFMEYER
TRUSTEE
701 PINE PLACE
RICE LAKE WI 54868

Officer/Director/Trustee Four

PAMELA SAVAS
TRUSTEE
N2220 LITTLE LONG LAKE RD
SHELL LAKE WI 54871

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/19/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 MATTHEW NELSON
Signature Title DIRECTOR
Signature Date 7/18/19

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