FORM 1023-EZ for FIGHT CLUB SURVIVOR

Field Data
EIN 47-3149424
Case Number EO-2015114-000255
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FIGHT CLUB SURVIVOR
Organization’s Mailing Address 10424 N 14500 E RD
City GRANT PARK
State IL
ZIP 60940
Accounting period End 12
Primary contact name GUILLERMO DELGADO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JEANNE WOKURKA
PRESIDENT
10424 N 14500 E RD
GRANT PARK IL 60940

Officer/Director/Trustee Two

BONNIE BEWSEY
VICE PRESIDENT
630 PENFIELD ST
BEECHER IL 60401

Officer/Director/Trustee Three

ANGELA MANDARINO
SECRETARY
359 COUNTY RD 135
ATHENS TN 37303

Officer/Director/Trustee Four

BRUCE SCHEIMAN
TREASURER
26103 S LOCUST PLACE
MONEE IL 60449

Organization’s website WWW.FIGHTCLUBSURVIVOR.ORG
Organization’s email ADMIN@FIGHTCLUBSURVIVOR.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/3/2015
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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