FORM 1023-EZ for CLOVERLEAF YOUTH FOOTBALL

Field Data
EIN 47-3802052
Case Number EO-2015124-000112
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLOVERLEAF YOUTH FOOTBALL
Organization’s Mailing Address 7933 RODGERS RD
City LODI
State OH
ZIP 44254
Accounting period End 12
Primary contact name DIANA KEMP
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JIM ZWEIFEL
DIRECTOR
SEVILLE RD
SEVILLE OH 44273

Officer/Director/Trustee Two

DIANA KEMP
PRESIDENT, TREASURER
7933 RODGERS RD
LODI OH 44254

Officer/Director/Trustee Three

KATHY KOVACEK
VICE PRESIDENT
SPENCER LAKE RD
MEDINA OH 44256

Officer/Director/Trustee Four

DOROTHY YOUNG
SECRETARY
5707 CHIPPEWA RD
CHIPPEWA LAKE OH 44215

Officer/Director/Trustee Five

FRANK KOVACEK
HEAD COACH/EQUIPMENT
SPENCER LAKE RD
MEDINA OH 44256

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2015
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N65 - Football Clubs, Leagues
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 Yes
Benefit of College No
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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