FORM 1023-EZ for LOST SOULS LAIR

Field Data
EIN 84-2708719
Case Number EO-2019227-000207
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LOST SOULS LAIR
Organization’s Mailing Address 320 MAPLE SUITE 110
City FORT COLLINS
State CO
ZIP 80521
Accounting period End 12
Primary contact name MARY LESLIE PATTERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THOMAS SEGELHORST
PRESIDENT
320 MAPLE ST SUITE 110
FORT COLLINS CO 80521

Officer/Director/Trustee Two

ROBIN MEEKER-GASTON
CHAIR
2018 WEST STUART
FORT COLLINS CO 80526

Officer/Director/Trustee Three

LISA BORTH
VICE PRESIDENT
1437 BEECH COURT
FORT COLLINS CO 80521

Officer/Director/Trustee Four

MARY PATTERSON
SECRETARY/TREASURER
320 MAPLE ST SUITE 110
FORT COLLINS CO 80521

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/12/19
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARY PATTERSON
Signature Title SECRETARY/TREASURER
Signature Date 8/13/19

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