FORM 1023-EZ for BELEGARTH MEDIEVAL COMBAT SOCIETY

Field Data
EIN 47-3718540
Case Number EO-2015106-000216
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BELEGARTH MEDIEVAL COMBAT SOCIETY
Organization’s Mailing Address 4409 WEST FRANKLIN ROAD
City BOISE
State ID
ZIP 83705-1337
Accounting period End 10
Primary contact name ANASTASIA NAGEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANASTASIA NAGEL
PRESIDENT
521 SOUTH LYON STREET UNIT 22
SANTA ANA CA 92701-6371

Officer/Director/Trustee Two

DAVID SHULER
VICE PRESIDENT
123 DANADA SQ E NUMBER 305 IL
WHEATON IL 60189-2008

Officer/Director/Trustee Three

MICHAEL RICHARD BIRCH
TREASURER
509 SOUTH WESTERN
PARK RIDGE IL 60068-4409

Officer/Director/Trustee Four

CHRISTOPHER T WEIR
PUBLIC RELATIONS COORDINATOR
1919 CANTERBURY DRIVE APT D
WASHINGTON IL 61571-3415

Officer/Director/Trustee Five

JOSHUA MATTSON
WEBMASTER
1004 CHERRYWOOD DR
CEDAR FALLS IA 50613-1614

Organization’s website WWW.BELEGARTH.COM
Organization’s email BOD@BELEGARTH.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/18/2013
Organization Incorporation State ID
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
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 Yes
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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