FORM 1023-EZ for SHOALS RURTIAN CLUB INC

Field Data
EIN 56-6076479
Case Number EO-2021215-000124
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHOALS RURTIAN CLUB INC
Organization’s Mailing Address 3025 SHOALS ROAD
City PINNACLE
State NC
ZIP 27043-9264
Accounting period End 12
Primary contact name JANIE INMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DWAYNE LIVENGOOD
PRESIDENT
178 LIVENGOOD LANE
PINNACLE NC 27043-9009

Officer/Director/Trustee Two

EDDIE BROWN
VICE PRESIDENT
3865 SHOALS ROAD
PINNACLE NC 27043-9288

Officer/Director/Trustee Three

JANIE INMAN
SECRETARY
739 CORNER ROAD
PINNACLE NC 27043-9369

Officer/Director/Trustee Four

GORDON JONES
TREASURER
310 KNOLLCREST DR
PINNACLE NC 27043-8264

Officer/Director/Trustee Five

NICK MABE
DIRECTOR
1361 HAUSER RD
PINNACLE NC 27043-8673

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/15/2005
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 Yes
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 Yes
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 JANIE INMAN
Signature Title SECRETARY
Signature Date 8/1/2021

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