FORM 1023-EZ for CLAYSBURG-KIMMEL ATHLETIC-ACTIVITYFOUNDATION

Field Data
EIN 84-2410958
Case Number EO-2021162-000200
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLAYSBURG-KIMMEL ATHLETIC-ACTIVITYFOUNDATION
Organization’s Mailing Address 531 BEDFORD ST
City CLAYSBURG
State PA
ZIP 16625-7701
Accounting period End 6
Primary contact name MICHELLE SMITHMYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELLE SMITHMYER
DIRECTOR
113 JUSTICE ST
HOLLIDAYSBURG PA 16648

Officer/Director/Trustee Two

DARREN MCLAURIN
DIRECTOR
1415 TEDS WAY
DUNCANSVILLE PA 16635

Officer/Director/Trustee Three

BRIAN HELSEL
DIRECTOR
716 N MONTGOMERY ST
HOLLIDAYSBURG PA 16648

Organization’s website
Organization’s email MSMITHMYER@CKSBULLDOGS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/4/2019
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B20 - Elementary, Secondary Education, K - 12
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 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 MICHELLE SMITHMYER
Signature Title DIRECTOR
Signature Date 6/9/2021

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