FORM 1023-EZ for MANSFIELD CHAPTER WARTHOGS MOTORCYCLE CLUB

Field Data
EIN 45-2698657
Case Number EO-2015156-000091
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MANSFIELD CHAPTER WARTHOGS MOTORCYCLE CLUB
Organization’s Mailing Address 4892 TEETER RD
City BELLVILLE
State OH
ZIP 44813
Accounting period End 12
Primary contact name ANDREW MEDWID
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHAWN SELVAGE
PRESIDENT
1836 TOWNSHIP ROAD 555
JEROMESVILLE OH 44840

Officer/Director/Trustee Two

LONNY MITCHELL
VICE PRESIDENT
2644 WASHINGTON NORTH RD
MANSFIELD OH 44903

Officer/Director/Trustee Three

ALLEN COLE
TREASURER
4892 TEETER RD
BELLVILLE OH 44813

Officer/Director/Trustee Four

SHAWN SHELTON
SECRETARY
7773 COUNTY ROAD 20
MOUNT GILEAD OH 43338

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/28/2010
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M12 - 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 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 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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