FORM 1023-EZ for LOST SIERRA COMPOSITE MOUNTAIN BIKING TEAM

Field Data
EIN 84-4766364
Case Number EO-2020168-000121
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LOST SIERRA COMPOSITE MOUNTAIN BIKING TEAM
Organization’s Mailing Address 604 W HIGH STREET
City QUINCY
State CA
ZIP 95971
Accounting period End 12
Primary contact name PAMELA BECWAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CAMERON FALCONER
PRESIDENT
545 HILLSIDE DR
QUINCY CA 95971

Officer/Director/Trustee Two

DEBBIE COLLETTE
SECRETARY
371 3RD STREET
QUINCY CA 95971

Officer/Director/Trustee Three

CAROL KLEM
TREASURER
3081 RIDGERUN RD
QUINCY CA 95971

Officer/Director/Trustee Four

JEFFREY DUPRAS
VICE PRESIDENT
636 PINELEAF DR
MEADOW VALLEY CA 95956

Officer/Director/Trustee Five

DANA MARTY
HEAD COACH
1954 WILDWOOD PATH
QUINCY CA 95971

Organization’s website HTTPS://LOSTSIERRACOMPMTB.WEEBLY.COM/
Organization’s email LOSTSIERRA MTB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/18/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
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 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 CAROL KLEM
Signature Title TREASURER
Signature Date 6/14/2020

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