FORM 1023-EZ for POTOMAC AIKIKAI INC

Field Data
EIN 81-1428974
Case Number EO-2017165-000239
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name POTOMAC AIKIKAI INC
Organization’s Mailing Address 58 RUTHERFORD CIR
City STERLING
State VA
ZIP 20165
Accounting period End 1
Primary contact name JEFF TAYLOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFFREY TAYLOR
DIRECTOR AND TREASURER
58 RUTHERFORD CIR
STERLING VA 20165

Officer/Director/Trustee Two

EDWARD JONES
DIRECTOR AND VICE PRESIDENT
9402 LAGOVISTA COURT
GREAT FALLS VA 22066

Officer/Director/Trustee Three

GREGORY HILGENBERG
DIRECTOR AND PRESIDENT
6604 CHENEY WAY
GAINSVILLE VA 20155

Officer/Director/Trustee Four

DIANA MANN
SECRETARY
44025 KINGS ARMS SQ
ASHBURN VA 20147

Officer/Director/Trustee Five

EDUARDO SANTOS
DIRECTOR
43790 MAISON BLANC SQ
ASHBURN VA 20148

Organization’s website WWW.POTOMACAIKIKAI.COM
Organization’s email POTOMACAIKIDO@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/9/2016
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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