FORM 1023-EZ for FOREST LAKE CAMP ALUMNI SCHOLARSHIP FUND INC

Field Data
EIN 82-0764124
Case Number EO-2018010-000247
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOREST LAKE CAMP ALUMNI SCHOLARSHIP FUND INC
Organization’s Mailing Address 2315 STATE ROUTE 9N
City LAKE GEORGE
State NY
ZIP 12845
Accounting period End 12
Primary contact name REBECCA J HERRICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TOBIN KELLY
DIRECTOR
81 CHARLES RIVER ST
NEEDHAM MA 2492

Officer/Director/Trustee Two

GEOFFREY BLANCK
DIRECTOR
225 W PINNACLE RIDGE RD
WATERBURY VT 5676

Officer/Director/Trustee Three

REBECCA J HERRICK
DIRECTOR
2315 STATE ROUTE 9N
LAKE GEORGE NY 12845

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/6/17
Organization Incorporation State NY
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: Yes
Religious: No
Educational: No
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 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 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 REBECCA J HERRICK
Signature Title DIRECTOR
Signature Date 1/8/18

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