FORM 1023-EZ for QUEEN ANNES COUNTY HIGH SCHOOL ICEHOCKEY ASSOCIATION

Field Data
EIN 83-1475523
Case Number EO-2019219-000314
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name QUEEN ANNES COUNTY HIGH SCHOOL ICEHOCKEY ASSOCIATION
Organization’s Mailing Address PO BOX 374
City CENTREVILLE
State MD
ZIP 21617
Accounting period End 6
Primary contact name STACI FAIRBANK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACI FAIRBANK
PRESIDENT
515 MASON BRANCH ROAD
QUEEN ANNE MD 21657

Officer/Director/Trustee Two

STACEY ADAMS
VICE PRESIDENT
241 GREEN STREET
CENTREVILLE MD 21617

Officer/Director/Trustee Three

JUDY MELCHIORRE
SECRETARY
101 BANDBRIDGE AVENUE
CENTREVILLE MD 21617

Officer/Director/Trustee Four

BRANDY MILLIGAN
TREASURER
310 MALCOLM DRIVE
CENTREVILLE MD 21617

Officer/Director/Trustee Five

KIM KIGHT
MEMBER AT LARGE
107 PLEASANT SPRING DRIVE
CENTREVILLE MD 21617

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/18
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N68 - Winter Sports (Snow and Ice)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 STACI FAIRBANK
Signature Title PRESIDENT
Signature Date 8/5/19
EIN 83-1475523
Case Number EO-2019219-000314
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name QUEEN ANNES COUNTY HIGH SCHOOL ICE HOCKEY ASSOCIATION
Organization’s Mailing Address PO BOX 374
City CENTREVILLE
State MD
ZIP 21617
Accounting period End 6
Primary contact name STACI FAIRBANK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACI FAIRBANK
PRESIDENT
515 MASON BRANCH ROAD
QUEEN ANNE MD 21657

Officer/Director/Trustee Two

STACEY ADAMS
VICE PRESIDENT
241 GREEN STREET
CENTREVILLE MD 21617

Officer/Director/Trustee Three

JUDY MELCHIORRE
SECRETARY
101 BANDBRIDGE AVENUE
CENTREVILLE MD 21617

Officer/Director/Trustee Four

BRANDY MILLIGAN
TREASURER
310 MALCOLM DRIVE
CENTREVILLE MD 21617

Officer/Director/Trustee Five

KIM KIGHT
MEMBER AT LARGE
107 PLEASANT SPRING DRIVE
CENTREVILLE MD 21617

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/18
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N68 - Winter Sports (Snow and Ice)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 STACI FAIRBANK
Signature Title PRESIDENT
Signature Date 8/5/19

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