FORM 1023-EZ for KIWANIS CLUB OF NORTHEAST SHELBY COUNTY FOUNDATION

Field Data
EIN 84-2885792
Case Number EO-2019259-000807
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KIWANIS CLUB OF NORTHEAST SHELBY COUNTY FOUNDATION
Organization’s Mailing Address PO BOX 492
City ARLINGTON
State TN
ZIP 38002
Accounting period End 9
Primary contact name DONNY MAYO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DONNY MAYO
PRESIDENT
5353 SHETLAND TRAIL
ARLINGTON TN 38002

Officer/Director/Trustee Two

JILL PETERSON-JONES
SECRETARY
6432 BEVAN DRIVE EAST
ARLINGTON TN 38002

Officer/Director/Trustee Three

TONY MICHAEL
VICE PRESIDENT
11177 HWY 70 STE 201
ARLINGTON TN 38002

Officer/Director/Trustee Four

HUNTER RASBACH
TREASURER
1880 CRANSTON RD
ARLINGTON TN 38002

Organization’s website
Organization’s email NESCKIWANIS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/1/19
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O12 - Fund Raising and/or Fund Distribution
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 DONNY MAYO
Signature Title PRESIDENT
Signature Date 9/12/19

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