FORM 1023-EZ for TRIELEMENTS FITNESS INC

Field Data
EIN 84-4297375
Case Number EO-2020044-000332
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TRIELEMENTS FITNESS INC
Organization’s Mailing Address 3894 BUR OAK RD
City SAN BERNARDINO
State CA
ZIP 92407
Accounting period End 12
Primary contact name JOHN LEE III
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN LEE III
DIRECTOR
3894 BUR OAK RD
SAN BERNARDINO CA 92407

Officer/Director/Trustee Two

RAPHAEL AMEY
PRESIDENT
31067 NICE
MENTONE CA 92359

Officer/Director/Trustee Three

SCOTT BARNETT
TREASURER
5025 CERVETTI AVE
RANCHO CUCAMONGA CA 91739

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/22/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T30 - Public Foundations
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 Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name JOHN LEE III
Signature Title DIRECTOR
Signature Date 2/11/2020

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