FORM 1023-EZ for POIEMA ATHLETIC STUDENT SUCCESS INC

Field Data
EIN 86-2874620
Case Number EO-2021137-000185
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POIEMA ATHLETIC STUDENT SUCCESS INC
Organization’s Mailing Address 9175 MCKENDREE RD
City WESLEY CHAPEL
State FL
ZIP 33545
Accounting period End 12
Primary contact name PATRICIA J FRIED
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RUSS HENDERSON
CHAIR
29547 CHAPEL PARK DR
WESLEY CHAPEL FL 33543

Officer/Director/Trustee Two

JESSICA AVILES
VICE CHAIR
142 BOG ROAD
CAMPTON NH 03223

Officer/Director/Trustee Three

EARL VIZZA
SECRETARY TREASURER
25836 RISEN STAR DR
WESLEY CHAPEL FL 33544

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/21/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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 RUSS HENDERSON
Signature Title CHAIR
Signature Date 5/12/2021

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