FORM 1023-EZ for SOUTHSIDE VIRGINIA ATHLETIC CLUB

Field Data
EIN 47-4048034
Case Number EO-2015225-000400
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHSIDE VIRGINIA ATHLETIC CLUB
Organization’s Mailing Address 15241 CHRISTANNA HWY
City LAWRENCEVILLE
State VA
ZIP 23868
Accounting period End 12
Primary contact name JUAN RIVAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JUAN RIVAS
PRESIDENT
15241 CHRISTANNA HIGHWAY
LAWRENCEVILLE VA 23868

Officer/Director/Trustee Two

KENDALL MORRIS
VICE PRESIDENT
559 CLARKE ROAD
LAWRENCEVILLE VA 23868

Officer/Director/Trustee Three

JESSICA RIVAS
TREASURER
15241 CHRISTANNA HIGHWAY
LAWRENCEVILLE VA 23868

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/16/2015
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: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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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