FORM 1023-EZ for CRYSTAL LAKE YOUTH MODEL FOR BASKETBALL

Field Data
EIN 47-1878821
Case Number EO-2015042-000057
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CRYSTAL LAKE YOUTH MODEL FOR BASKETBALL
Organization’s Mailing Address 301 CONGRESS PARKWAY UNIT 511
City CRYSTAL LAKE
State IL
ZIP 60039
Accounting period End 12
Primary contact name RYAN P FARRELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RICH CZESLAWSKI
DIRECTOR
301 E CONGRESS PKWY 511
Crystal Lake IL 60039

Officer/Director/Trustee Two

ROBERT FETZNER
DIRECTOR
5116 W ELM ST
McHenry IL 60050

Officer/Director/Trustee Three

ERIC SAMUELSON
DIRECTOR
1145 S RT 31 UNIT 145
CRYSTAL LAKE IL 60014

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/2014
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N62 - Basketball
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 Yes
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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