FORM 1023-EZ for POLYNESIAN PICKLEBALL CLUB

Field Data
EIN 86-3936212
Case Number EO-2021193-000674
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POLYNESIAN PICKLEBALL CLUB
Organization’s Mailing Address 1840 S 900 W
City LEHI
State UT
ZIP 84043
Accounting period End 10
Primary contact name ALYN TOALEPAI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALYN TOALEPAI
OFFICER
1840 S 900 W
LEHI UT 84043

Officer/Director/Trustee Two

MARK ANGILAU
DIRECTOR
3763 BETH PARK DR
WEST VALLEY CITY UT 84120

Officer/Director/Trustee Three

SARAH TOALEPAI
OFFICER
1840 S 900 W
LEHI UT 84043

Officer/Director/Trustee Four

FRANK MOUNGA
TRUSTEE 1
1359 GENERAL DRIVE
SALT LAKE CITY UT 84116

Officer/Director/Trustee Five

ROSELLA VEHIKITE
TRUSTEE 2
3634 S DESIGNER COURT
WEST VALLEY CITY UT 84119

Organization’s website
Organization’s email ADMIN@POLYNESIANPICKLEBALLCLUB.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/19/2021
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 Yes
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 ALYN TOALEPAI
Signature Title OFFICER
Signature Date 7/8/2021

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