FORM 1023-EZ for 30 CLUB COMMUNITY CHARITY FOUNDATION

Field Data
EIN 84-1520741
Case Number EO-2016049-000195
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 30 CLUB COMMUNITY CHARITY FOUNDATION
Organization’s Mailing Address PO BOX 62
City PUEBLO
State CO
ZIP 81002
Accounting period End 12
Primary contact name CHAD HEBERLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TODD KELLY
DIRECTOR
4319 RIDGE DR
PUEBLO CO 81008

Officer/Director/Trustee Two

SCOTT ROBB
DIRECTOR
5438 STONEMOOR DR
PUEBLO CO 81005

Officer/Director/Trustee Three

JAMES OLIVER
DIRECTOR
612 W 18TH ST
PUEBLO CO 81003

Officer/Director/Trustee Four

CHAD HEBERLY
DIRECTOR
237 W ELBOW DR
PUEBLO WEST CO 81007

Officer/Director/Trustee Five

MARK WELTE
DIRECTOR
1131 MOUNTAINSIDE PL
PUEBLO WEST CO 81007

Organization’s website
Organization’s email 30CLUBPUEBLO@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/18/1999
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O12 - Fund Raising and/or Fund Distribution
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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