FORM 1023-EZ for PATRIOT ACADEMIC BOOSTER CLUB

Field Data
EIN 83-1006561
Case Number EO-2019056-000478
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PATRIOT ACADEMIC BOOSTER CLUB
Organization’s Mailing Address 3434 MAPLE AVENUE
City TERRE HAUTE
State IN
ZIP 47804
Accounting period End 12
Primary contact name DENISE PENDERGAST
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMIEE HUXFORD
PRESIDENT
3434 MAPLE AVENUE
TERRE HAUTE IN 47804

Officer/Director/Trustee Two

KAY PONSOT
VICE PRESIDENT
3434 MAPLE AVENUE
TERRE HAUTE IN 47804

Officer/Director/Trustee Three

RACHELE GRASSICK
SECRETARY
3434 MAPLE AVENUE
TERRE HAUTE IN 47804

Officer/Director/Trustee Four

DENISE PENDERGAST
TREASURER
3434 MAPLE AVENUE
TERRE HAUTE IN 47804

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/18
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
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 Yes
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 JAMIEE HUXFORD
Signature Title PRESIDENT
Signature Date 2/22/19

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