FORM 1023-EZ for LSYB

Field Data
EIN 83-2292158
Case Number EO-2018309-000385
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LSYB
Organization’s Mailing Address 3343 AUGUSTA NATIONAL DR S
City SALEM
State OR
ZIP 97302
Accounting period End 12
Primary contact name JASON HERBER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JASON HERBER
PROGRAM DIRECTOR
3343 AUGUSTA NATIONAL DR S
SALEM OR 97302

Officer/Director/Trustee Two

ADRIAN LEWIS
SSHS HEAD GIRLS COACH
1910 CHURCH ST SE
SALEM OR 97302

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N62 - Basketball
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
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 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 JASON HERBER
Signature Title PROGRAM DIRECTOR
Signature Date 11/2/18

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