FORM 1023-EZ for VALLEY FUSION CLUB VB

Field Data
EIN 83-3017983
Case Number EO-2020147-000202
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name VALLEY FUSION CLUB VB
Organization’s Mailing Address 9869 PARADISE ROAD
City ALAMOSA
State CO
ZIP 81101
Accounting period End 12
Primary contact name SHAE HASLETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHAE HASLETT
PRESIDENT
9869 PARADISE ROAD
ALAMOSA CO 81101

Officer/Director/Trustee Two

NEREYDA MARTINEZ
BOARD MEMBER
19 WILLOW DRIVE
LA JARA CO 81140

Officer/Director/Trustee Three

DEANNA NOGA
BOARD MEMBER
82 EL CAMINO
ALAMOSA CO 81101

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/4/2019
Organization Incorporation State CO
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: 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 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 SHAE HASLETT
Signature Title PRESIDENT
Signature Date 5/21/2020

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