FORM 1023-EZ for ELKHORN SOUTH DANCE TEAM PARENTS BOOSTER CLUB

Field Data
EIN 83-0818851
Case Number EO-2021039-000153
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ELKHORN SOUTH DANCE TEAM PARENTS BOOSTER CLUB
Organization’s Mailing Address 19255 WALNUT ST
City OMAHA
State NE
ZIP 68130
Accounting period End 3
Primary contact name JACKIE BERGMANN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACY FALK
PRESIDENT / DIRECTOR
1420 S 194TH ST
OMAHA NE 68130

Officer/Director/Trustee Two

TENNYSON OWENS
VICE PRESIDENT / DIRECTOR
21359 CEDAR CIR
ELKHORN NE 68022

Officer/Director/Trustee Three

JACQUELINE BERGMANN
SECRETARY / DIRECTOR
19255 WALNUT ST
OMAHA NE 68130

Officer/Director/Trustee Four

DENISE SHOTBOLT
TREASURER / DIRECTOR
3314 S 185TH AVE
OMAHA NE 68130

Officer/Director/Trustee Five

GLYNNIS DITTRICK
DIRECTOR
1218 S 200TH ST
OMAHA NE 68130

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/7/2018
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JACQUELINE BERGMANN
Signature Title SECRETARY / DIRECTOR
Signature Date 12/21/2020

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