FORM 1023-EZ for CLUB CROSSOVER BASKETBALL INC

Field Data
EIN 84-5110113
Case Number EO-2020268-000437
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLUB CROSSOVER BASKETBALL INC
Organization’s Mailing Address 1995 GLENDON WAY
City PLEASANT GROVE
State UT
ZIP 84062
Accounting period End 12
Primary contact name RYAN VAN DORN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RYAN VAN DORN
PRESIDENT
1995 GLENDON WAY
PLEASANT GROVE UT 84062

Officer/Director/Trustee Two

TIFFANY VAN DORN
CHIEF FINANCIAL OFFICER
1995 GLENDON WAY
PLEASANT GROVE UT 84062

Officer/Director/Trustee Three

ZACH SIMON
CHAIRPERSON
1995 GLENDON WAY
PLEASANT GROVE UT 84062

Officer/Director/Trustee Four

AARON ATKINSON
OFFICER
1995 GLENDON WAY
PLEASANT GROVE UT 84062

Officer/Director/Trustee Five

SCOTT CROCKETT
DIRECTOR
1995 GLENDON WAY
PLEASANT GROVE UT 84062

Organization’s website WWW.CLUBCROSSOVER.COM
Organization’s email CLUBCROSSOVERBASKETBALL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/5/2020
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N62 - Basketball
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 RYAN VAN DORN
Signature Title PRESIDENT
Signature Date 9/22/2020

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