FORM 1023-EZ for SYNAPSE FITNESS FOUNDATION

Field Data
EIN 83-1549761
Case Number EO-2019170-000153
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SYNAPSE FITNESS FOUNDATION
Organization’s Mailing Address 3176 NW FOXTAIL PL
City CORVALLIS
State OR
ZIP 97330
Accounting period End 6
Primary contact name KELLY ROSE BECKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELLY BECKER
PRESIDENT & FOUNDER
3176 NW FOXTAIL PL
CORVALLIS OR 97330

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/13/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N30 - Physical Fitness and Community Recreational Facilities
Organization’s purpose Charitable: Yes
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 KELLY BECKER
Signature Title PRESIDENT & FOUNDER
Signature Date 6/17/19

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