FORM 1023-EZ for TRI-COUNTY SPORTS CLUB INC

Field Data
EIN 23-2640921
Case Number EO-2015322-000268
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TRI-COUNTY SPORTS CLUB INC
Organization’s Mailing Address 755 COUNTY LINE ROAD
City LACEYVILLE
State PA
ZIP 18623
Accounting period End 12
Primary contact name CARL YURGATIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CARL YURGATIS
PRESIDENT
755 COUNTY LINE ROAD
LACEYVILLE PA 18623

Officer/Director/Trustee Two

WILLARD VALVANO
TREASURER
31 HILL TOP DRIVE
TUNKHANNOCK PA 18657

Officer/Director/Trustee Three

DALE BENNETT
SECRETARY
705 BOARD ROAD
LACEYVILLE PA 18623

Officer/Director/Trustee Four

PATRICK BEEBE
VICE PRESIDENT
118 BEEBE ROAD
WYALUSING PA 18853

Organization’s website
Organization’s email YURGATIS@EPIX.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/20/1975
Organization Incorporation State PA
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: Yes
Religious: No
Educational: No
Scientific: No
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 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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