FORM 1023-EZ for FALLS LAKE ACADEMY ATHLETIC BOOSTERCLUB

Field Data
EIN 46-3801844
Case Number EO-2014356-000269
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FALLS LAKE ACADEMY ATHLETIC BOOSTERCLUB
Organization’s Mailing Address 1701 EAST LYON STATION ROAD
City CREEDMOOR
State NC
ZIP 27522
Accounting period End 6
Primary contact name JENNIFER BACKUS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JEFF HEDGEPETH
PRESIDENT
2563 WINDING CREEK LANE
FRANKLINTON NC 27525

Officer/Director/Trustee Two

JENNIFER BACKUS
VICE PRESIDENT
2647 BOWDEN DRIVE
CREEDMOOR NC 27522

Officer/Director/Trustee Three

BETH GEORGE
SECRETARY
141 CARRIAGE HILL DRIVE
STEM NC 27581

Officer/Director/Trustee Four

ASHLEY SLAUGHTER
TREASURER
3181 EAST LYON STATION ROAD
CREEDMOOR NC 27522

Officer/Director/Trustee Five

JENNIFER OAKLEY
MEMBER-AT-LARGE
4216 EAST GEER STREET
DURHAM NC 27704

Organization’s website HTTP://WWW.FALLSLAKEACADEMYATHLETICS.COM/
Organization’s email PATRICKVINCENT@FALLSLAKEACADEMY.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/26/2014
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B94 - Parent/Teacher Group
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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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