FORM 1023-EZ for SOUTHWEST YOUTH CLUB

Field Data
EIN 54-1919082
Case Number EO-2015338-000058
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHWEST YOUTH CLUB
Organization’s Mailing Address 11532 HULL STREET ROAD PO BOX 5570
City MIDLOTHIAN
State VA
ZIP 23112
Accounting period End 6
Primary contact name JAMES WASHINGTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JAMES WASHINGTON
DIRECTOR/PRESIDENT
2412 ARROWOOD ROAD
MIDLOTHIAN VA 23112

Officer/Director/Trustee Two

JAMES ADAMS
DIRECTOR
8867 EMERALD DUNES CIRCLE
CHESTERFIELD VA 23832

Officer/Director/Trustee Three

JENNIFER ORFIELD
DIRECTOR
2300 CRICKHOLLOW CT
RICHMOND VA 23233

Officer/Director/Trustee Four

WILLIAM SHIFLETT
DIRECTOR
6207 ARBOR BANKS TERR
CHESTER VA 23831

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/2/2015
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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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