FORM 1023-EZ for ATHLETIC CLUB O

Field Data
EIN 81-4051010
Case Number EO-2017193-000330
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ATHLETIC CLUB O
Organization’s Mailing Address 1514 JAMES STREET
City PLATTSMOUTH
State NE
ZIP 68048
Accounting period End 4
Primary contact name JAYSON SWIFT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAYSON SWIFT
TREASURER
1514 JAMES STREET
PLATTSMOUTH NE 68048

Officer/Director/Trustee Two

DUSTIN WILSON
PRESIDENT
11506 MAASS ROAD APT 204
BELLEVUE NE 68123

Officer/Director/Trustee Three

DOMINIQUE HUGHES
SECRETARY
2913 HALIFAX DRIVE
BELLEVUE NE 68123

Officer/Director/Trustee Four

DEONTE STEWART
VICE PRESIDENT
9559 PARK DRIVE
OMAHA NE 68123

Organization’s website
Organization’s email SOCCER16INSANE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/26/2017
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N70 - Amateur Sports Competitions
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 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
Signature Title
Signature Date

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