FORM 1023-EZ for CAMPBELL PONY BASEBALL INCORPORATED

Field Data
EIN 27-2163672
Case Number EO-2016274-000196
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAMPBELL PONY BASEBALL INCORPORATED
Organization’s Mailing Address 5057 WILLIAMS ROAD
City SAN JOSE
State CA
ZIP 95129
Accounting period End 12
Primary contact name CINDY MEDEIROS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROGER MARSHALL
PRESIDENT
PO BOX 1013
CAMPBELL CA 95009

Officer/Director/Trustee Two

CYNTHIA MEDEIROS
VICE PRESIDENT
5057 WILLIAMS ROAD
SAN JOSE CA 95129

Officer/Director/Trustee Three

TIM THOMPSON
SECRETARY
3768 XAVIER COURT
CAMPBELL CA 95008

Officer/Director/Trustee Four

DAN MEDEIROS
PONY REP
5057 WILLIAMS ROAD
SAN JOSE CA 95129

Officer/Director/Trustee Five

VERN ENRIQUEZ
PLAYER AGENT
PO BOX 1013
CAMPBELL CA 95009

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/25/2010
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N63 - Baseball, Softball
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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