FORM 1023-EZ for COLORADO WHEELCHAIR LACROSSE FOUNDATION

Field Data
EIN 83-3760661
Case Number EO-2019084-000704
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COLORADO WHEELCHAIR LACROSSE FOUNDATION
Organization’s Mailing Address 551 S NOME ST
City AURORA
State CO
ZIP 80012
Accounting period End 12
Primary contact name CHRISTOPHER DALE BROCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTOPHER BROCK
COUNCIL/DIRECTOR
551 S NOME ST
AURORA CO 80012

Officer/Director/Trustee Two

DANIEL HERSH
PRESIDENT
3232 TAMARAC LANE
JOHNSTOWN CO 80534

Officer/Director/Trustee Three

ROB SHAHADE
VICE PRESIDENT
3815 S KNOX CT
DENVER CO 80236

Officer/Director/Trustee Four

JOHN VCELKA
TREASURER
10115 S PEORIA ST APT 1-107
PARKER CO 80534

Officer/Director/Trustee Five

ELLE DERBY
SECRETARY
3815 S KNOX CT
DENVER CO 80236

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/23/19
Organization Incorporation State CO
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: No
Religious: No
Educational: Yes
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 CHRISTOPHER BROCK
Signature Title COUNCIL/DIRECTOR
Signature Date 3/23/19

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