FORM 1023-EZ for TN JAYS SSA YOUTH ORGANIZATION

Field Data
EIN 38-4005405
Case Number EO-2019169-000422
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TN JAYS SSA YOUTH ORGANIZATION
Organization’s Mailing Address 205 MANHATTAN AVE
City OAK RIDGE
State TN
ZIP 37830
Accounting period End 12
Primary contact name DOMINICK PENDERGRASS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOMINICK PENDERGRASS
CEO
205 MANHATTAN AVE
OAK RIDGE TN 37830

Officer/Director/Trustee Two

ALTHEA PENDERGRASS
EXECUTIVE ASSISTANT
205 MANHATTAN AVE
OAK RIDGE TN 37830

Officer/Director/Trustee Three

LATASHA BELL
CONCESSION GEN MANAGER
103C WAKEFIELD RD
OAK RIDGE TN 37830

Organization’s website WWW.TNJAYS.COM
Organization’s email TNJAYS722@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/11/16
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
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 ALTHEA PENDERGRASS
Signature Title EXECUTIVE ASSISTANT
Signature Date 6/14/19

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