FORM 1023-EZ for THETA OMICRON FOUNDATION INC
| Field | Data |
|---|---|
| EIN | 81-3742110 |
| Case Number | EO-2018174-000025 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | THETA OMICRON FOUNDATION INC |
| Organization’s Mailing Address | 7617 ROLLING OAK CT |
| City | CLEMMONS |
| State | NC |
| ZIP | 27012-9145 |
| Accounting period End | 8 |
| Primary contact name | DERRICK S BOONE SR |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
LOUIS NEWSOME
PRESIDENT
4201 HUNTCLIFF CT
APEX NC 27539
Officer/Director/Trustee Two
HUGH HOLSTON
VICE-PRESIDENT
4 CRAWFORD CT
GREENSBORO NC 27406
Officer/Director/Trustee Three
KELVIN ANTHONY
TREASURER
1511 N DAVIS ST
WEST TX 76691
Officer/Director/Trustee Four
TERRY WALLACE
SECRETARY
5821 FAIRVIEW ROAD SUITE 110
CHARLOTTE NC 28209
Officer/Director/Trustee Five
DERRICK BOONE SR
DIRECTOR
7617 ROLLING OAK CT
CLEMMONS NC 27012
| Organization’s website | N/A |
|---|---|
| Organization’s email | THETAOMICRONFOUNDATION@GMAIL.COM |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 9/9/16 |
| Organization Incorporation State | NC |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | T30 - Public Foundations |
| 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 | DERRICK BOONE SR |
| Signature Title | DIRECTOR |
| Signature Date | 6/20/18 |
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