FORM 1023-EZ for FAYETTEVILLE COMMUNITY CENTER GROUP

Field Data
EIN 83-1336361
Case Number EO-2019035-000198
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAYETTEVILLE COMMUNITY CENTER GROUP
Organization’s Mailing Address 201 W FAYETTE ST
City FAYETTEVILLE
State TX
ZIP 78940-5019
Accounting period End 12
Primary contact name JERRY HERRING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOUG MITCHELL
PRESIDENT
421 SHUMACHER RD
FAYETTEVILLE TX 78940-5456

Officer/Director/Trustee Two

JERRY HERRING
SECRETARY
1488 FM 2503
ELLINGER TX 78938-5031

Officer/Director/Trustee Three

STEPHEN CUSHING
BOARD MEMBER
108 S CHURCH
FAYETTEVILLE TX 78940-5568

Officer/Director/Trustee Four

HAKAN ROSENGREN
BOARD MEMBER
211 W FAYETTE
FAYETTEVILLE TX 78940-5548

Officer/Director/Trustee Five

MARYANN HEIMSATH
BOARD MEMBER
103 N WASHINGTON
FAYETTEVILLE TX 78940-5548

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/4/18
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A61 - Performing Arts Centers
Organization’s purpose Charitable: Yes
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 JERRY HERRING
Signature Title SECRETARY
Signature Date 1/9/19

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