FORM 1023-EZ for JACKS CLUBHOUSE

Field Data
EIN 85-1105861
Case Number EO-2020163-000145
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACKS CLUBHOUSE
Organization’s Mailing Address 939 MANHATTAN AVENUE
City MANHATTAN BEACH
State CA
ZIP 90266
Accounting period End 12
Primary contact name GRACE LOU
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MITZI HENRY
PRESIDENT
939 MANHATTAN BOULEVARD
MANHATTAN BEACH CA 90266

Officer/Director/Trustee Two

STEPHEN HENRY
SECRETARY
939 MANHATTAN BOULEVARD
MANHATTAN BEACH CA 90266

Officer/Director/Trustee Three

STEPHEN HENRY
TREASURER
939 MANHATTAN BOULEVARD
MANHATTAN BEACH CA 90266

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/14/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, Services
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name STEPHEN HENRY
Signature Title TREASURER
Signature Date 6/9/2020

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