FORM 1023-EZ for LONG BEACH POLY HIGH SCHOOL BOOSTERCLUB

Field Data
EIN 81-2965105
Case Number EO-2016208-000413
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LONG BEACH POLY HIGH SCHOOL BOOSTERCLUB
Organization’s Mailing Address 1600 ATLANTIC AVENUE
City LONG BEACH
State CA
ZIP 90813-2017
Accounting period End 6
Primary contact name SCOTT ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CRAIG FLEMING
CHIEF EXECUTIVE OFFICER
5430 E CARITA STREET
LONG BEACH CA 90808-2540

Officer/Director/Trustee Two

TOM VADAKAN
SECRETARY
6848 E DRISCOLL STREET
LONG BEACH CA 90815-4807

Officer/Director/Trustee Three

SCOTT ANDERSON
CHIEF FINANCIAL OFFICER
396 WINSLOW AVENUE
LONG BEACH CA 90814-3212

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/26/1992
Organization Incorporation State CA
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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