FORM 1023-EZ for BLACK GOLD CLUB INC

Field Data
EIN 47-1457423
Case Number EO-2016130-000046
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLACK GOLD CLUB INC
Organization’s Mailing Address 12052 MARYHILL CT
City MEQUON
State WI
ZIP 53092-2235
Accounting period End 12
Primary contact name BRANDON KING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JIMMY LEMKE
PRESIDENT
12052 MARYHILL CT
MEQUON WI 53092-2235

Officer/Director/Trustee Two

KEN PETERSON
VICE PRESIDENT
12052 MARYHILL CT
MEQUON WI 53092-2235

Officer/Director/Trustee Three

BRANDON KING
EVENTS COORDINATOR
12052 MARYHILL CT
MEQUON WI 53092-2235

Officer/Director/Trustee Four

DERICK KELLY
SECRETARY
12052 MARYHILL CT
MEQUON WI 53092-2235

Organization’s website BLACKANDGOLDCLUB.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/27/2014
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
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 Yes
Donation of funds Yes
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 No
Benefit of College Yes
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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