FORM 1023-EZ for LINE MOUNTAIN HS FOOTBALL BOOSTER

Field Data
EIN 47-4924576
Case Number EO-2016055-000168
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LINE MOUNTAIN HS FOOTBALL BOOSTER
Organization’s Mailing Address 943 CRISSINGER HILL RD
City SUNBURY
State PA
ZIP 17801-5727
Accounting period End 12
Primary contact name SHANNON BROSIOUS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID MOORE
PRESIDENT
268 BLACK LANE
SHAMOKIN PA 17872-7745

Officer/Director/Trustee Two

JINAE BOYER
VICE-PRESIDENT
1928 GEORGE STREET
DALMATIA PA 17017-7169

Officer/Director/Trustee Three

SHANNON BROSIOUS
TREASURER
943 CRISSINGER HILL ROAD
SUNBURY PA 17801-5727

Officer/Director/Trustee Four

KIM SHAFFER
SECRETARY
549 CEMETARY ROAD
DALMATIA PA 17017-9622

Officer/Director/Trustee Five

DINA BIDDING
RECORDING SECRETARY
296 TREVORTON ROAD
SHAMOKIN PA 17872-6524

Organization’s website N/A
Organization’s email SRBROSIOUS@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/3/2016
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
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 No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
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
Signature Title
Signature Date

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