FORM 1023-EZ for PHOENIX ICCD CLUBHOUSE INCORPORATED

Field Data
EIN 83-0620313
Case Number EO-2018171-000628
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PHOENIX ICCD CLUBHOUSE INCORPORATED
Organization’s Mailing Address 2410 BUFFALO GAP ROAD APT 221
City ABILENE
State TX
ZIP 79605-6148
Accounting period End 12
Primary contact name WILLIAM A BOYD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM BOYD
CHAIRMAN
2410 BUFFALO GAP ROAD APT 221
ABILENE TX 79605-6148

Officer/Director/Trustee Two

SAMANTHA MANSKI
VICE CHAIRMAN
333 ORANGE
ABILENE TX 79601-5929

Officer/Director/Trustee Three

AMANDA UPHILL
SECRETARY
104 PINE STREET 2ND FLOOR
ABILENE TX 79601-5929

Organization’s website HTTPS://PHOENIXICCD.ORG
Organization’s email INFO@PHOENIXICCD.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/16/18
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F32 - Community Mental Health Center
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 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 WILLIAM BOYD
Signature Title CHAIRMAN
Signature Date 6/18/18

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