FORM 1023-EZ for CLAY INTERNATIONAL ACADEMY PARENT TEACHER STUDENT ORGANIZATION

Field Data
EIN 84-3272869
Case Number EO-2019302-000157
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLAY INTERNATIONAL ACADEMY PARENT TEACHER STUDENT ORGANIZATION
Organization’s Mailing Address 52900 LILY ROAD
City SOUTH BEND
State IN
ZIP 46637-3228
Accounting period End 12
Primary contact name MELINDA FOUNTAIN-PRESIDENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELINDA FOUNTAIN
PRESIDENT
52900 LILY ROAD
SOUTH BEND IN 46637-3228

Officer/Director/Trustee Two

GREGG PANTALE
TREASURER
52900 LILY ROAD
SOUTH BEND IN 46637-3228

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/11/19
Organization Incorporation State IN
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: 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 MELINDA FOUNTAIN
Signature Title PRESIDENT
Signature Date 10/25/19

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