FORM 1023-EZ for EMPOWER LACROSSE CLUB INC

Field Data
EIN 81-1339195
Case Number EO-2016144-000256
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMPOWER LACROSSE CLUB INC
Organization’s Mailing Address 16 DOWNING STREET
City HANOVER
State NH
ZIP 03755
Accounting period End 6
Primary contact name REESE BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

REESE BROWN
PRESIDENT DIRECTOR
3436 CHURCH HILL ROAD
WOODSTOCK VT 05091

Officer/Director/Trustee Two

VICKI REBECCA MCCORKLE
TREASURER DIRECTOR
29 MACDONALD DRIVE
HANOVER NH 03755

Officer/Director/Trustee Three

WHITAKER HAGERMAN WILLOCKS
SECRETARY DIRECTOR
47 LYME ROAD NUMBER 3
HANOVER NH 03755

Officer/Director/Trustee Four

SARAH HOLLY MARTIN
DIRECTOR
92 CARPENTER STREET
NORWICH VT 05055

Officer/Director/Trustee Five

JILLIAN HANSEN COLLINS
DIRECTOR
271 BRIGHAM HILL ROAD
NORWICH VT 05055

Organization’s website EMPOWERLACROSSECLUB.COM
Organization’s email REESE@EMPOWERLACROSSECLUB.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/28/2015
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
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 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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