FORM 1023-EZ for PUBLIC SAFETY ATHLETIC TRAINERS SOCIETY

Field Data
EIN 45-1058790
Case Number EO-2017072-000413
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PUBLIC SAFETY ATHLETIC TRAINERS SOCIETY
Organization’s Mailing Address 11118 HABOR CT
City RESTON
State VA
ZIP 20191
Accounting period End 12
Primary contact name NANCY BURKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NANCY BURKE
EXECUTIVE DIRECTOR
11118 HABOR CT
RESTON VA 20191

Officer/Director/Trustee Two

WOODY GOFFINETT
PRESIDENT
1436 BIRCH BARK CT
DAYTON OH 45440

Officer/Director/Trustee Three

DEENA KILPATRICK
VICE PRESIDENT
212 JULIAN PT
CIBOLO TX 78108

Officer/Director/Trustee Four

KATIE STAUFFER
SECRETARY
3917 MONTOGMERY AVE APT A
CLOUMBIA SC 29205

Officer/Director/Trustee Five

BRAD SWOPE
TREASURER
114 FAIRFWAYS DR
HENDERSONVILLE TN 37075

Organization’s website WWW.PSATSOCIETY.COM
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/2011
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G03 - Professional Societies, Associations
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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