FORM 1023-EZ for CHAUTAUQUA CHILDRENS GYM

Field Data
EIN 83-4370811
Case Number EO-2019126-000219
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CHAUTAUQUA CHILDRENS GYM
Organization’s Mailing Address 40 HOLMES PL
City FREDONIA
State NY
ZIP 14063
Accounting period End 12
Primary contact name DAWN J MANZELLA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAWN MANZELLA
DIRECTOR
40 HOLMES PL
FREDONIA NY 14063

Officer/Director/Trustee Two

ANTONIO MANZELLA
BOARD MEMBER
40 HOLMES PL
FREDONIA NY 14063

Officer/Director/Trustee Three

SHARON RINEHART
BOARD MEMBER
9423 DYE ROAD
FORESTVILLE NY 14062

Officer/Director/Trustee Four

LAURA LEBARRON
BOARD MEMBER
12139 FORESTVILLE RD
SILVER CREEK NY 14136

Officer/Director/Trustee Five

JESSICA OLSEN
BOARD MEMBER
3053 ROUTE 39
FORESTVILLE NY 14062

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/12/19
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
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 DAWN MANZELLA
Signature Title DIRECTOR
Signature Date 5/2/19

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