FORM 1023-EZ for CLUB PALMYRA

Field Data
EIN 81-2796822
Case Number EO-2016235-000325
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLUB PALMYRA
Organization’s Mailing Address 4841 OHIO ROAD
City WELLSVILLE
State KS
ZIP 66092
Accounting period End 5
Primary contact name JOSIE FLORY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GREGORY LEWIS
PRESIDENT
119 E 1100TH ROAD
BALDWIN CITY KS 66006

Officer/Director/Trustee Two

BO ENRIGHT
VICE PRESIDENT
304 E 2100 ROAD
WELLSVILLE KS 66092

Officer/Director/Trustee Three

JENNIFER LANGE
CLUB MANAGER
8410 FREDERICK COURT
DESOTO KS 66018

Officer/Director/Trustee Four

SARA RICE
SECRETARY
926 JASARA CIRCLE
BALDWIN CITY KS 66006

Officer/Director/Trustee Five

JOSIE FLORY
TREASURER
4841 OHIO ROAD
WELLSVILLE KS 66092

Organization’s website WWW.CLUBPALMYRA.COM
Organization’s email TREASURER@CLUBPALMYRA.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2016
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
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
Signature Title
Signature Date

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