FORM 1023-EZ for LIGHTHOUSE GYM NFP

Field Data
EIN 85-0808279
Case Number EO-2020147-000298
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIGHTHOUSE GYM NFP
Organization’s Mailing Address 1440 WAGON TOWN RD
City GOREVILLE
State IL
ZIP 62939-3036
Accounting period End 12
Primary contact name BART PULLIAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BART PULLIAM
PRESIDENT
1440 WAGON TOWN RD
GOREVILLE IL 62939-3036

Officer/Director/Trustee Two

SHANNON PULLIAM
DIRECTOR
1440 WAGON TOWN RD
GOREVILLE IL 62939-3036

Officer/Director/Trustee Three

DAVID MANN
DIRECTOR
2737 KOKOPELLI DR
MARION IL 62959-5213

Officer/Director/Trustee Four

SUSAN MANN
DIRECTOR
2737 KOKOPELLI DR
MARION IL 62959-5213

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/14/2019
Organization Incorporation State IL
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: 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 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 BART PULLIAM
Signature Title PRESIDENT
Signature Date 5/21/2020

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