FORM 1023-EZ for TEAM FUSION

Field Data
EIN 30-0831690
Case Number EO-2016337-000427
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TEAM FUSION
Organization’s Mailing Address 18005 SE KELLY CT
City PORTLAND
State OR
ZIP 97236
Accounting period End 12
Primary contact name ERIC LEDECKY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERIC LEDECKY
DIRECTOR
18005 SE KELLY CT
PORTLAND OR 97236

Officer/Director/Trustee Two

CARYN JOHNSON
OFFICER
16899 SE BERGHAMMER ST
MILWAUKIE OR 97267

Organization’s website TEAMFUSIONPDX.COM
Organization’s email TEAMFUSIONDBTEAM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/2014
Organization Incorporation State OR
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: No
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
Signature Title
Signature Date

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