FORM 1023-EZ for ALTUS H2O CLUB

Field Data
EIN 82-1138230
Case Number EO-2017265-000282
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ALTUS H2O CLUB
Organization’s Mailing Address 20612 E CR 175
City ELMER
State OK
ZIP 73539
Accounting period End 6
Primary contact name MICHAEL SHIVE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JIM BROWN
PRESIDENT
1212 CANTERBURY BLVD
ALTUS OK 73521

Officer/Director/Trustee Two

WENDY PARKER
VICE PRESIDENT
700 WINDSOR
ALRUS OK 73521

Officer/Director/Trustee Three

PATRICIA PURDUE
TREASURER
1521 CAMBRIDGE DRIVE
ALTUS OK 73521

Officer/Director/Trustee Four

JENNIFER BROWN
SECRETARY
812 ROSEHAVEN
ALTUS OK 73539

Officer/Director/Trustee Five

MICHAEL SHIVE
DIRECTOR
20612 E CR 175
ELMER OK 73539

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/13/2017
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N62 - Basketball
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 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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